Solution Manual for Case Studies for Health Information Management, 2nd Edition
richard@qwconsultancy.com
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Instructor Manual to Accompany Case Studies in Health Information Management
Charlotte McCuen, MS, RHIA Nanette B. Sayles, EdD, RHIA, CCS, CHP, CPHIMS, FAHIMA
Patricia J. Schnering, RHIA, CCS
Contents RHIA and RHIT Competency Crosswalk for Case Studies ................................................. xiii Preface .............................................................................................................................xxvii
Section 1
Health Data Management
Case 1-1
Subjective, Objective, Assessment, and Plan (SOAP) Statements and the Problem-Oriented Medical Record (POMR) ......................................................................... 2
Case 1-2
Problem-Oriented Medical Record (POMR) Record Format ................................................ 4
Case 1-3
Master Patient Index (MPI) and Duplicate Medical Record Number Assignment ............................................................................................................................. 5
Case 1-4
Enterprise MPI (E-MPI)......................................................................................................... 6
Case 1-5
Chart Check-Out Screen Design and Data Quality.............................................................. 10
Case 1-6
Patient Demographic Data Entry Screen Design and Data Quality .................................... 11
Case 1-7
Encounter Abstract Screen Design and Data Quality .......................................................... 13
Case 1-8
Coding Abstract Data Entry Screen Design and Data Quality ............................................ 15
Case 1-9
Designing a Report for Radiology and Imaging Service Examinations ............................... 16
Case 1-10
Documentation Requirements for the History and Physical Report ..................................... 17
Case 1-11
Documentation Requirements for the Autopsy Report ......................................................... 19
Case 1-12
Data Collection in Long-Term Care: Minimum Data Set Version 3.0 (MDS 3.0) ............................................................................................................................ 20
Case 1-13
Data Collection for the Health Plan Employer Data and Information Set: (HEDIS) in Managed Care ................................................................................................... 25
Case 1-14
Birth Certificate Reporting Project ...................................................................................... 28
Case 1-15
Clinical Coding Systems and Technology ............................................................................ 31
Case 1-16
External Administrative Requirements: ORYX™ Performance Measures for the Joint Commission and CMS ...................................................................................... 32
Case 1-17
Joint Commission Mock Survey ............................................................................................ 33
Case 1-18
Authentication Compliance .................................................................................................. 35
Case 1-19
Primary Ambulatory Care Center EHR and Meaningful Use .............................................. 36
Case 1-20
Case Finding for Tumor Registry ......................................................................................... 38
Case 1-21
Face Validity of QI Study on Births ...................................................................................... 39
Case 1-22
Reproductive History Interpretation..................................................................................... 40
Case 1-23
Abstract of Pertinent Inpatient Medical Documentation ...................................................... 41
Case 1-24
Choosing a Personal Health Record (PHR) ......................................................................... 42
Case 1-25
Personal Health Record (PHR) Education ........................................................................... 43 References ............................................................................................................................ 44
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Instructor Manual to Accompany Case Studies in Health Information Management iv
Section 2
Clinical Classification Systems and Reimbursement Methods
Case 2-1
Official Coding Resource ..................................................................................................... 48
Case 2-2
Coding Quality in ICD-9-CM ............................................................................................... 51
Case 2-3
Documentation Support for Principal Diagnosis ................................................................. 54
Case 2-4
Improving Coding Quality ................................................................................................... 57
Case 2-5
Chargemaster Audit.............................................................................................................. 59
Case 2-6
Chargemaster Maintenance ................................................................................................. 60
Case 2-7
Selecting Coding Classification Systems .............................................................................. 63
Case 2-8
Presentation on ICD-10-CM and ICD-10-PCS .................................................................... 64
Case 2-9
Encoder Functional Requirements ....................................................................................... 69
Case 2-10
Encoder Selection ................................................................................................................. 72
Case 2-11
Request for Information (RFI) on Encoder Systems ............................................................. 74
Case 2-12
Physician Query Policy ........................................................................................................ 76
Case 2-13
Physician Query Evaluation ................................................................................................. 79
Case 2-14
Physician Education ............................................................................................................. 81
Case 2-15
Using Workflow Technology in Physician Query Management ........................................... 83
Case 2-16
Physician Orders for Outpatient Testing .............................................................................. 84
Case 2-17
Report Generation ................................................................................................................ 85
Case 2-18
Monitoring Compliance Activities ........................................................................................ 86
Case 2-19
Potential Compliance Issue .................................................................................................. 88
Case 2-20
Discharge Planning .............................................................................................................. 93
Case 2-21
Documentation Improvement ............................................................................................... 94
Case 2-22
Strategic Management of ICD-10 Implementation ............................................................... 96
Case 2-23
Developing a Coding Quality Plan ...................................................................................... 98
Case 2-24
High-Risk Medicare-Severity Diagnosis-Related Groups (MS-DRGs) .............................. 101
Case 2-25
Medicare-Severity Diagnosis-Related Group (MS-DRG) Comparisons ............................ 103
Case 2-26
Medicare-Severity Diagnosis-Related Group (MS-DRG) Changes ................................... 107
Case 2-27
Complication/Comorbidity (CC) Medicare-Severity Diagnosis-Related Group (MS-DRG) Analysis ........................................................................................................... 109
Case 2-28
Estimated Medicare-Security Diagnosis-Related Group (MS-DRG) Payments ................. 113
Case 2-29
Case Mix Index (CMI) Trends ............................................................................................ 115
Case 2-30
Case Mix Index (CMI) Investigation .................................................................................. 118
Case 2-31
Top 10 Medicare-Security Diagnosis-Related Groups (MS-DRGs) ................................... 121
Case 2-32
Case Mix Index (CMI) Analysis.......................................................................................... 124
Case 2-33
Medicare Provider Analysis and Review (MEDPAR) Data Analysis ................................. 127
Case 2-34
Explanation of Benefits (EOB) ........................................................................................... 130
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Instructor Manual to Accompany Case Studies in Health Information Management v
Case 2-35
Qualification for Insurance ................................................................................................ 132
Case 2-36
Medicare Part D ................................................................................................................. 134
Case 2-37
Medicare Coverage ............................................................................................................ 136
Case 2-38
Local Care Determination (LCD) ...................................................................................... 138
Case 2-39
National Coverage Determination (NCD) .......................................................................... 140
Case 2-40
Calculating Medicare Inpatient Psychiatric Reimbursement ............................................ 142
Case 2-41
Medical Necessity ............................................................................................................... 143
Case 2-42
Calculating Commercial Insurance Reimbursement .......................................................... 146
Case 2-43
Ambulatory Payment Classification (APC) ....................................................................... 148
Case 2-44
Discharged Not Final Billed (DNFB) Reduction ............................................................... 150
Case 2-45
Chargemaster Updates ...................................................................................................... 153
Case 2-46
Monitoring Revenue Cycle ................................................................................................ 154
Case 2-47
Corrective Action Plan ...................................................................................................... 156 References .......................................................................................................................... 157
Section 3
Statistics and Quality Improvement
Case 3-1
Inpatient Service Days ........................................................................................................ 163
Case 3-2
Average Daily Census ........................................................................................................ 164
Case 3-3
Length of Stay (LOS) .......................................................................................................... 165
Case 3-4
Average Length of Stay (ALOS).......................................................................................... 166
Case 3-5
Percentage of Occupancy for Month .................................................................................. 168
Case 3-6
Percentage of Occupancy for Year ..................................................................................... 170
Case 3-7
Consultation Rate ............................................................................................................... 172
Case 3-8
Nosocomial and Community-Acquired Infection Rate ....................................................... 173
Case 3-9
Incidence Rate .................................................................................................................... 175
Case 3-10
Comparative Heath Data: Hospital Mortality Statistics .................................................... 176
Case 3-11
Joint Commission Hospital Quality Check ......................................................................... 179
Case 3-12
Nursing Home Comparative Data ...................................................................................... 183
Case 3-13
Residential Care Facilities in Long-Term Care (LTC) ...................................................... 184
Case 3-14
Relative Risk Comparison .................................................................................................. 185
Case 3-15
Determining Appropriate Formulas: Ratios ..................................................................... 186
Case 3-16
Calculating Obstetrics (OB) Statistics................................................................................ 187
Case 3-17
Research Cesarean Section Trend ...................................................................................... 191
Case 3-18
Hospital Statistics Spreadsheet .......................................................................................... 193
Case 3-19
Benchmarks for Leading Causes of Death ......................................................................... 195
Case 3-20
Death Trends for Heart and Malignant Neoplasms ........................................................... 198
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Instructor Manual to Accompany Case Studies in Health Information Management vi
Case 3-21
Principal Diagnosis and Principal Procedures for U.S. Hospitalizations ........................ 201
Case 3-22
Diagnostic-Related Groups (DRGs) and Revenue ............................................................. 204
Case 3-23
DRG 110 versus DRG 111 Cost Analysis (DRG version 10) ............................................. 208
Case 3-24
Calculating Physician Service Statistics ............................................................................ 212
Case 3-25
Determining the Percentage of Patients with Unacceptable Waiting Time ....................... 214
Case 3-26
Systems Analysis of Health Information Management (HIM) Function from Clinical Experience.................................................................................................... 216
Case 3-27
Clinical Quality Improvement Literature Research ........................................................... 217
Case 3-28
Quality Improvement (QI)/Performance Improvement (PI) Interview Project ................................................................................................................................ 219
Case 3-29
Research Report Utilizing NCHS Public Database ............................................................ 220
Case 3-30
Septicemic Hospitalizations as Principal Diagnosis vs. Secondary Diagnosis............................................................................................................................ 221
Case 3-31
Pain Assessment Study ....................................................................................................... 223
Case 3-32
Coronary Artery Bypass Graft Postoperative LOS ............................................................ 225
Case 3-33
Skyview Hospital Monthly Statistical Report ..................................................................... 227 References .......................................................................................................................... 229
Section 4
Healthcare Privacy, Confidentiality, Legal, and Ethical Issues
Case 4-1
Notice of Privacy Practices ................................................................................................ 233
Case 4-2
Accounting for Disclosure of Protected Health Information (PHI) Under the Health Insurance Portability and Accountability Act .................................................. 234
Case 4-3
Legal Issues in Accounting for Disclosure of Protected Health Information (PHI) to the Health Department ..................................................................... 236
Case 4-4
Patient’s Right to Amend Record ....................................................................................... 237
Case 4-5
Institutional Process for Patient Request to Amend Record ............................................... 238
Case 4-6
Alteration of Patient Record ............................................................................................... 240
Case 4-7
Investigating Privacy Violations ........................................................................................ 241
Case 4-8
Investigation of Breach of Privacy ..................................................................................... 243
Case 4-9
Privacy Violation by Former Employee ............................................................................. 244
Case 4-10
Privacy and Security Training for New Staff ...................................................................... 245
Case 4-11
Release of Information (ROI), Staff Privacy, and Privacy Rule Training Test ..................................................................................................................................... 246
Case 4-12
Compliance with Privacy Training..................................................................................... 249
Case 4-13
Privacy Plan Gap Analysis ................................................................................................. 250
Case 4-14
Security Measures for Access to Protected Health Information ......................................... 251
Case 4-15
Breach Notification ............................................................................................................ 252
Case 4-16
Breach of Information at Business Associate ..................................................................... 253
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Instructor Manual to Accompany Case Studies in Health Information Management vii
Case 4-17
Access to Health Information for Treatment ...................................................................... 254
Case 4-18
Monitoring Regulations Affecting Healthcare (Federal Register) ..................................... 255
Case 4-19
Monitoring Legislation Affecting Healthcare (THOMAS) ................................................. 256
Case 4-20
Responsibilities in Release of Information (ROI) ............................................................... 257
Case 4-21
Release of Information and the “Legal Health Record” .................................................... 258
Case 4-22
Authorization for Release of Information (ROI) ................................................................. 259
Case 4-23
Processing Requests for Release of Information (ROI) ...................................................... 260
Case 4-24
Reporting Communicable Diseases .................................................................................... 262
Case 4-25
Disclosure of Information from a Psychiatric Record ........................................................ 264
Case 4-26
Processing a Request for Information from an Attorney .................................................... 265
Case 4-27
Processing a Request for Health Information from a Patient ............................................ 266
Case 4-28
Processing a Request for Certified Copy of Health Information ........................................ 267
Case 4-29
Processing a Request for Health Information for Worker’s Compensation ....................... 268
Case 4-30
Valid Authorization for Requests for Release of Information (ROI) .................................. 269
Case 4-31
Health Information Management (HIM) Department Process for Subpoenas for Release of Information (ROI) ..................................................................... 270
Case 4-32
Validate Subpoenas for Release of Information (ROI) ....................................................... 271
Case 4-33
Quality and Performance Improvement in Release of Information (ROI) Turnaround Time................................................................................................................ 272
Case 4-34
Updating the Retention and Destruction Policy for Healthcare Records........................... 274
Case 4-35
Evaluating Records for Destruction ................................................................................... 275
Case 4-36
Developing a Documentation Destruction Plan ................................................................. 276
Case 4-37
Research Studies and Ethics ............................................................................................... 277
Case 4-38
Identity Theft....................................................................................................................... 278
Case 4-39
American Health Information Management Association (AHIMA) Code of Ethics .................................................................................................................................. 279 References .......................................................................................................................... 280
Section 5
Information Technology and Systems
Case 5-1
System Conversion ............................................................................................................. 285
Case 5-2
Web Page Design ............................................................................................................... 289
Case 5-3
Policy and Procedure Development ................................................................................... 291
Case 5-4
Database Design ................................................................................................................ 293
Case 5-5
Database Development ....................................................................................................... 296
Case 5-6
System Selection ................................................................................................................. 299
Case 5-7
System Life Cycle ................................................................................................................ 301
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Instructor Manual to Accompany Case Studies in Health Information Management viii
Case 5-8
Data Collection Questionnaire and Interview Questions for Systems Analysis .............................................................................................................................. 305
Case 5-9
Developing Data Collection Plan for Systems Analysis ..................................................... 307
Case 5-10
Information System Project Steering Committee ................................................................ 310
Case 5-11
Developing a System Selection Plan .................................................................................. 312
Case 5-12
System Selection ................................................................................................................. 315
Case 5-13
System Testing Plan ............................................................................................................ 318
Case 5-14
Workflow Technology ......................................................................................................... 321
Case 5-15
Developing a Workflow Plan .............................................................................................. 323
Case 5-16
Goals of the Electronic Health Record (EHR) ................................................................... 327
Case 5-17
Computerized Provider Order Entry Implementation ....................................................... 329
Case 5-18
Normalization of Data Fields ............................................................................................. 331
Case 5-19
Human Resource Database ................................................................................................ 334
Case 5-20
Tumor Registry System Questionnaire ............................................................................... 335
Case 5-21
Bar Code Standards ........................................................................................................... 337
Case 5-22
Bar Code Policy ................................................................................................................. 339
Case 5-23
Conversion of Admission Discharge Transfer (ADT) System ............................................. 341
Case 5-24
Admission Report Design ................................................................................................... 343
Case 5-25
Choosing Software Packages ............................................................................................. 345
Case 5-26
General Office Software ..................................................................................................... 347
Case 5-27
Selecting an Internet-Based Personal Health Record (PHR) ............................................. 349
Case 5-28
Data Warehouse Development ........................................................................................... 351
Case 5-29
Data Tables ........................................................................................................................ 354
Case 5-30
Electronic Forms Management System .............................................................................. 356
Case 5-31
Failure of an Electronic Health Record (EHR) System ..................................................... 358
Case 5-32
Preparation for an Electronic Health Record (EHR) System ............................................. 361
Case 5-33
Employee System Access Termination Procedure .............................................................. 363
Case 5-34
Intranet Functionality ......................................................................................................... 365
Case 5-35
Evaluating Systems for Privacy Regulations Compliance .................................................. 367
Case 5-36
Website Resources .............................................................................................................. 369
Case 5-37
Voice Recognition Editing ................................................................................................. 370
Case 5-38
Storage Requirements ......................................................................................................... 372
Case 5-39
Quality Control of Scanning ............................................................................................... 374
Case 5-40
Contingency Planning ........................................................................................................ 376
Case 5-41
Business Continuity Planning ............................................................................................. 378
Case 5-42
Audit Triggers..................................................................................................................... 380
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Instructor Manual to Accompany Case Studies in Health Information Management ix
Case 5-43
Password Management ...................................................................................................... 382
Case 5-44
Electronic Health Record (EHR) Security Plan ................................................................. 384
Case 5-45
Electronic Health Record (EHR) Training Plan ................................................................ 388
Case 5-46
Strategic Planning .............................................................................................................. 391
Case 5-47
Single Vendor or Best of Breed .......................................................................................... 394
Case 5-48
Functional Requirements of a Transcription System .......................................................... 396
Case 5-49
Health Information Exchange ............................................................................................ 399
Case 5-50
Personal Health Record ..................................................................................................... 400
Case 5-51
Public Health ...................................................................................................................... 402
Case 5-52
HL7 EHR System Functional Model .................................................................................. 403
Case 5-53
Data Mining ....................................................................................................................... 404
Case 5-54
Database Queries ............................................................................................................... 405
Case 5-55
Meaningful Use .................................................................................................................. 407
Case 5-56
Clinical Vocabularies ......................................................................................................... 408 References .......................................................................................................................... 409
Section 6
Management and Health Information Services
Case 6-1
Developing an Organizational Chart for Health Information Management (HIM) ........... 413
Case 6-2
Writing a Policy and Procedure ......................................................................................... 415
Case 6-3
Work Measurement Study ................................................................................................... 419
Case 6-4
Evaluating Employees’ Skills ............................................................................................. 422
Case 6-5
Recruiting Resources .......................................................................................................... 425
Case 6-6
Recruitment Advertisement ................................................................................................. 427
Case 6-7
Interviewing Job Applicants ............................................................................................... 428
Case 6-8
Job Applicant and the Americans with Disabilities Act (ADA) .......................................... 429
Case 6-9
Developing a Training Plan ............................................................................................... 431
Case 6-10
Department Coverage ........................................................................................................ 432
Case 6-11
Decision Making................................................................................................................. 433
Case 6-12
Progressive Disciplinary Approach ................................................................................... 434
Case 6-13
Falsification of Information on Employment Application .................................................. 438
Case 6-14
Time Management .............................................................................................................. 440
Case 6-15
Interdepartmental Communications ................................................................................... 442
Case 6-16
Merit Raise ......................................................................................................................... 443
Case 6-17
Incentive-Based Compensation Programs ......................................................................... 444
Case 6-18
Payroll Budget Decisions ................................................................................................... 449
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Instructor Manual to Accompany Case Studies in Health Information Management x
Case 6-19
Budgeting for Reducing Payroll ......................................................................................... 452
Case 6-20
Calculating Salary Increases.............................................................................................. 453
Case 6-21
Planning for Paper-Based Record Retention ..................................................................... 459
Case 6-22
Planning for Electronic Record Retention ......................................................................... 463
Case 6-23
Calculating Department Operations Budget ...................................................................... 465
Case 6-24
Net Present Value (NPV) Method of Evaluating a Capital Expense .................................. 469
Case 6-25
Accounting Rate of Return Method of Evaluating a Capital Expense ................................ 470
Case 6-26
Payback Method of Evaluating a Capital Expense ............................................................ 471
Case 6-27
Developing the HIM Operations Budget ............................................................................ 473
Case 6-28
Developing the HIM Department Budget ........................................................................... 476
Case 6-29
Filing System Conversions ................................................................................................. 482 References .......................................................................................................................... 485
Section 7
Project and Operations Management
Case 7-1
Organizational Charts ........................................................................................................ 488
Case 7-2
Job Description Analysis .................................................................................................... 490
Case 7-3
Productivity Study .............................................................................................................. 492
Case 7-4
Performance and Quality Improvement in a Coding Department ...................................... 493
Case 7-5
Performance Improvement for a File Area ........................................................................ 496
Case 7-6
Instituting Productivity and Quality Standards for Imaging or Scanning Records ............ 498
Case 7-7
Evaluation of Transcription Department............................................................................ 500
Case 7-8
Performance and Quality Evaluation and Improvement of Health Information Management (HIM) Department .................................................................... 504
Case 7-9
Creating a Workflow Diagram for Discharge Processing ................................................. 513
Case 7-10
Improving Workflow Process for Performance Improvement for Discharge Processing......................................................................................................... 516
Case 7-11
Physical Layout Design for Health Information Management (HIM) Department ......................................................................................................................... 518
Case 7-12
Revision of Information Management Plan ........................................................................ 519
Case 7-13
Defining a Project .............................................................................................................. 522
Case 7-14
Job Description for Project Manager................................................................................. 525
Case 7-15
Forming Committees .......................................................................................................... 526
Case 7-16
Committee to Perform System Benefits Analysis ................................................................ 531
Case 7-17
Project Management and Program Evaluation Review Technique (PERT) Chart ............ 532
Case 7-18
Project Management and Analysis of Gantt Chart ............................................................. 533
Case 7-19
Creating a Gantt Chart ...................................................................................................... 534
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Instructor Manual to Accompany Case Studies in Health Information Management xi
Case 7-20
Evaluation of Project Management Budget Variance ........................................................ 543
Case 7-21
Developing a Filing System and Evaluating Equipment Needs .......................................... 546
Case 7-22
Project Planning for Conversion from Alphabetic to Terminal Digit Filing ..................... 551
Case 7-23
Planning the Health Information Management (HIM) Department for a New Facility ..... 553
Case 7-24
Planning Release of Information (ROI) Department Functions for a New Facility ............................................................................................................................... 562 References .......................................................................................................................... 565
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Instructor Manual to Accompany Case Studies in Health Information Management xii
For the educators use in choosing appropriate cases studies for their classes, we have included Case Study Crosswalk for Associate and Baccalaureate Degrees Curriculum Competencies.
Case Study Crosswalk for Associate Degree Curriculum Competencies Domain 1 Domain 2 Domain 3 Domain 4 Health Statistics, Biomedical Research, and Health Services Information Health Data Quality Organization Technology Management Management and Delivery and Systems Case Section 1 Case 1-1 Case 1-2 Case 1-3 Case 1-4 Case 1-5 Case 1-6 Case 1-7 Case 1-8 Case 1-9 Case 1-10 Case 1-11 Case 1-12 Case 1-13 Case 1-14 Case 1-15 Case 1-16 Case 1-17 Case 1-18 Case 1-19 Case 1-20 Case 1-21 Case 1-22 Case 1-23 Case 1-24 Case 1-25 Section 2 Case 2-1 Case 2-2 Case 2-3 Case 2-4 Case 2-5 Case 2-6 Case 2-7 Case 2-8 Case 2-9 Case 2-10
X X X X X X X X X X X X X X X X X X X X X
X X X X X X X X X X X X X X X X X X
X X
X X X X X X X X X X
X X X X X X X X X X X X X X X X X X
X X X X X X
X X
X X
X X X
X X X X
Organization and Management
X
X X X X X X X X
X X
X
Domain 5
X X X X X X X
X X X X X
X
X X X X X X X X X X
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Instructor Manual to Accompany Case Studies in Health Information Management xiii
Case Study Crosswalk for Associate Degree Curriculum Competencies (continued) Domain 1 Domain 2 Domain 3 Domain 4 Domain 5 Health Statistics, Biomedical Research, and Health Services Information Organization Health Data Quality Organization Technology and Management Management and Delivery and Systems Management Case 2-11 X X X X Case 2-12 X X X X Case 2-13 X X X Case 2-14 X X X Case 2-15 X X X X Case 2-16 X X Case 2-17 X X X X Case 2-18 X X X Case 2-19 X X Case 2-20 X X Case 2-21 X X X X Case 2-22 X Case 2-23 X Case 2-24 X Case 2-25 X Case 2-26 X Case 2-27 X X Case 2-28 X X Case 2-29 X Case 2-30 X X Case 2-31 X Case 2-32 X Case 2-33 X Case 2-34 X Case 2-35 X Case 2-36 X Case 2-37 X Case 2-38 X Case 2-39 X Case 2-40 X Case 2-41 X Case 2-42 X Case 2-43 X Case 2-44 X Section 3 Case 3-1 Case 3-2 Case 3-3 Case 3-4
X X X X
X X X X
X X
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Instructor Manual to Accompany Case Studies in Health Information Management xiv
Case Study Crosswalk for Associate Degree Curriculum Competencies (continued) Domain 1 Domain 2 Domain 3 Domain 4 Domain 5 Health Statistics, Biomedical Research, and Health Services Information Organization Health Data Quality Organization Technology and Management Management and Delivery and Systems Management Case 3-5 Case 3-6 Case 3-7 Case 3-8 Case 3-9 Case 3-10 Case 3-11 Case 3-12 Case 3-13 Case 3-14 Case 3-15 Case 3-16 Case 3-17 Case 3-18 Case 3-19 Case 3-20 Case 3-21 Case 3-22 Case 3-23 Case 3-24 Case 3-25 Case 3-26 Case 3-27 Case 3-28 Case 3-29 Case 3-30 Case 3-31 Case 3-32 Case 3-33 Section 4 Case 4-1 Case 4-2 Case 4-3 Case 4-4 Case 4-5 Case 4-6 Case 4-7 Case 4-8 Case 4-9
X X X X X
X X X X X X X X X X
X X X X X X X X X X
X X X X X X X X X X X X X X X X X
X
X
X X
X
X X X X X
X
X X X
X X X X
X X X X X X X X X
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Instructor Manual to Accompany Case Studies in Health Information Management xv
Case Study Crosswalk for Associate Degree Curriculum Competencies (continued) Domain 1 Domain 2 Domain 3 Domain 4 Domain 5 Health Statistics, Biomedical Research, and Health Services Information Organization Health Data Quality Organization Technology and Management Management and Delivery and Systems Management Case 4-10 X X Case 4-11 X X Case 4-12 X X Case 4-13 X Case 4-14 X Case 4-15 X Case 4-16 X Case 4-17 X Case 4-18 X Case 4-19 X Case 4-20 X Case 4-21 X X Case 4-22 X Case 4-23 X Case 4-24 X Case 4-25 X Case 4-26 X Case 4-27 X Case 4-28 X Case 4-29 X Case 4-30 X Case 4-31 X Case 4-32 X Case 4-33 X X Case 4-34 X Case 4-35 X Case 4-36 X Case 4-37 X Case 4-38 X Case 4-39 X Section 5 Case 5-1 Case 5-2 Case 5-3 Case 5-4 Case 5-5 Case 5-6 Case 5-7 Case 5-8
X X X X X X X X
X
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Instructor Manual to Accompany Case Studies in Health Information Management xvi
Case Study Crosswalk for Associate Degree Curriculum Competencies (continued) Domain 1 Domain 2 Domain 3 Domain 4 Domain 5 Health Statistics, Biomedical Research, and Health Services Information Organization Health Data Quality Organization Technology and Management Management and Delivery and Systems Management Case 5-9 X Case 5-10 X Case 5-11 X Case 5-12 X Case 5-13 X Case 5-14 X Case 5-15 X Case 5-16 X Case 5-17 X Case 5-18 X Case 5-19 X Case 5-20 X Case 5-21 X Case 5-22 X Case 5-23 X Case 5-24 X Case 5-25 X Case 5-26 X Case 5-27 X X Case 5-28 X Case 5-29 X Case 5-30 X Case 5-31 X Case 5-32 X Case 5-33 X Case 5-34 X Case 5-35 X Case 5-36 X Case 5-37 X Case 5-38 X Case 5-39 X Case 5-40 X Case 5-41 X Case 5-42 X Case 5-43 X X Case 5-44 X Case 5-45 X Case 5-46 X X Case 5-47 X Case 5-48 X © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Instructor Manual to Accompany Case Studies in Health Information Management xvii
Case Study Crosswalk for Associate Degree Curriculum Competencies (continued) Domain 1 Domain 2 Domain 3 Domain 4 Domain 5 Health Statistics, Biomedical Research, and Health Services Information Organization Health Data Quality Organization Technology and Management Management and Delivery and Systems Management Case 5-49 X Case 5-50 X X Case 5-51 X Case 5-52 X Case 5-53 X Case 5-54 X Case 5-55 X Case 5-56 X Section 6 Case 6-1 Case 6-2 Case 6-3 Case 6-4 Case 6-5 Case 6-6 Case 6-7 Case 6-8 Case 6-9 Case 6-10 Case 6-11 Case 6-12 Case 6-13 Case 6-14 Case 6-15 Case 6-16 Case 6-17 Case 6-18 Case 6-19 Case 6-20 Case 6-21 Case 6-22 Case 6-23 Case 6-24 Case 6-25 Case 6-26 Case 6-27 Case 6-28 Case 6-29
X X
X X
X
X X
X
X
X X
X X
X
X
X
X X X X X X X X X X X X X X X X X X X X X X X X X X X X X
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Instructor Manual to Accompany Case Studies in Health Information Management xviii
Case Study Crosswalk for Associate Degree Curriculum Competencies (continued) Domain 1 Domain 2 Domain 3 Domain 4 Domain 5 Health Statistics, Biomedical Research, and Health Services Information Organization Health Data Quality Organization Technology and Management Management and Delivery and Systems Management Section 7 Case 7-1 X X Case 7-2 X X Case 7-3 X X X X Case 7-4 X X X Case 7-5 X X X X Case 7-6 X X Case 7-7 X X Case 7-8 X X X X X Case 7-9 X X X Case 7-10 X X X X Case 7-11 X X X X Case 7-12 X X X X X Case 7-13 X Case 7-14 X Case 7-15 X X Case 7-16 X X X X Case 7-17 X X Case 7-18 X X X Case 7-19 X X Case 7-20 X X X Case 7-21 X X Case 7-22 X X X X X Case 7-23 X X Case 7-24 X X X X
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Instructor Manual to Accompany Case Studies in Health Information Management xix
Case Study Crosswalk for Baccalaureate Degree Curriculum Competencies Domain 1 Domain 2 Domain 3 Domain 4 Domain 5 Health Statistics, Biomedical Health Research, and Services Information Organization Health Data Quality Organization Technology and Management Management and Delivery and Systems Management Case Section 1 Case 1-1 Case 1-2 Case 1-3 Case 1-4 Case 1-5 Case 1-6 Case 1-7 Case 1-8 Case 1-9 Case 1-10 Case 1-11 Case 1-12 Case 1-13 Case 1-14 Case 1-15 Case 1-16 Case 1-17 Case 1-18 Case 1-19 Case 1-20 Case 1-21 Case 1-22 Case 1-23 Case 1-24 Case 1-25 Section 2 Case 2-1 Case 2-2 Case 2-3 Case 2-4 Case 2-5 Case 2-6 Case 2-7 Case 2-8 Case 2-9
X X X X X X X X X X X X X X X X X X X X X
X X X X X X X X X X X X X X X X X X
X X
X X X X X X X X X
X X X X X X X X X X X X X X X X X X
X X X X X X
X X
X X
X X X
X X X X X X X X
X X
X
X X X X
X
X X X X X X
X X X X X
X
X X X X X X X X X
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Instructor Manual to Accompany Case Studies in Health Information Management xx
Case Study Crosswalk for Baccalaureate Degree Curriculum Competencies (continued) Domain 1 Domain 2 Domain 3 Domain 4 Domain 5 Health Statistics, Biomedical Health Research, and Services Information Organization Health Data Quality Organization Technology and Management Management and Delivery and Systems Management Case 2-10 X X X Case 2-11 X X X X Case 2-12 X X X X Case 2-13 X X X Case 2-14 X X X Case 2-15 X X X X Case 2-16 X X Case 2-17 X X X X Case 2-18 X X X Case 2-19 X X Case 2-20 X X Case 2-21 X X X X Case 2-22 X X X X Case 2-23 X X X Case 2-24 X X X Case 2-25 X Case 2-26 X X Case 2-27 X X Case 2-28 X X Case 2-29 X X Case 2-30 X X X Case 2-31 X X X Case 2-32 X X X Case 2-33 X Case 2-34 X Case 2-35 X Case 2-36 X Case 2-37 X Case 2-38 X Case 2-39 X Case 2-40 X Case 2-41 X Case 2-42 X Case 2-43 X Case 2-44 X Case 2-45 X X Case 2-46 X X Case 2-47 X X © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Instructor Manual to Accompany Case Studies in Health Information Management xxi
Case Study Crosswalk for Baccalaureate Degree Curriculum Competencies (continued) Domain 1 Domain 2 Domain 3 Domain 4 Domain 5
Health Data Management Section 3 Case 3-1 Case 3-2 Case 3-3 Case 3-4 Case 3-5 Case 3-6 Case 3-7 Case 3-8 Case 3-9 Case 3-10 Case 3-11 Case 3-12 Case 3-13 Case 3-14 Case 3-15 Case 3-16 Case 3-17 Case 3-18 Case 3-19 Case 3-20 Case 3-21 Case 3-22 Case 3-23 Case 3-24 Case 3-25 Case 3-26 Case 3-27 Case 3-28 Case 3-29 Case 3-30 Case 3-31 Case 3-32 Case 3-33
X X X X X X X X X X
Health Statistics, Biomedical Research, and Quality Management X X X X X X X X X X X X X X X
Health Services Organization and Delivery
Information Technology and Systems
Organization and Management
X X X X X X X X X X X X X
X
X X
X X X X X X X X X X X X X X X X X
X X
X X X X X
X
X X X
X X X X
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Instructor Manual to Accompany Case Studies in Health Information Management xxii
Case Study Crosswalk for Baccalaureate Degree Curriculum Competencies (continued) Domain 1 Domain 2 Domain 3 Domain 4 Domain 5 Health Data Health Health Information Organization Management Statistics, Services Technology and Biomedical Organization and Systems Management Research, and and Delivery Quality Management Section 4 Case 4-1 X Case 4-2 X Case 4-3 X Case 4-4 X Case 4-5 X Case 4-6 X Case 4-7 X Case 4-8 X Case 4-9 X Case 4-10 X X Case 4-11 X X Case 4-12 X X Case 4-13 X X Case 4-14 X Case 4-15 X Case 4-16 X Case 4-17 X Case 4-18 X Case 4-19 X Case 4-20 X Case 4-21 X Case 4-22 X Case 4-23 X Case 4-24 X Case 4-25 X Case 4-26 X Case 4-27 X Case 4-28 X Case 4-29 X Case 4-30 X Case 4-31 X Case 4-32 X Case 4-33 X X Case 4-34 X Case 4-35 X Case 4-36 X Case 4-37 X Case 4-38 X Case 4-39 X © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Instructor Manual to Accompany Case Studies in Health Information Management xxiii
Case Study Crosswalk for Baccalaureate Degree Curriculum Competencies (continued) Domain 1 Domain 2 Domain 3 Domain 4 Domain 5 Health Data Health Health Information Organization Management Statistics, Services Technology and Biomedical Organization and Systems Management Research, and and Delivery Quality Management Section 5 Case 5-1 X Case 5-2 X Case 5-3 X X Case 5-4 X Case 5-5 X Case 5-6 X Case 5-7 X Case 5-8 X Case 5-9 X Case 5-10 X Case 5-11 X Case 5-12 X Case 5-13 X Case 5-14 X Case 5-15 X Case 5-16 X Case 5-17 X Case 5-18 X Case 5-19 X Case 5-20 X Case 5-21 X Case 5-22 X Case 5-23 X Case 5-24 X Case 5-25 X Case 5-26 X Case 5-27 X Case 5-28 X Case 5-29 X Case 5-30 X Case 5-31 X Case 5-32 X Case 5-33 X Case 5-34 X Case 5-35 X Case 5-36 X Case 5-37 X © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Instructor Manual to Accompany Case Studies in Health Information Management xxiv
Case Study Crosswalk for Baccalaureate Degree Curriculum Competencies (continued) Domain 1 Domain 2 Domain 3 Domain 4 Domain 5 Health Data Health Health Information Organization Management Statistics, Services Technology and Biomedical Organization and Systems Management Research, and and Delivery Quality Management Case 5-38 X Case 5-39 X Case 5-40 X Case 5-41 X Case 5-42 X Case 5-43 X Case 5-44 X Case 5-45 X Case 5-46 X X Case 5-47 X Case 5-48 X Case 5-49 X Case 5-50 X Case 5-51 X Case 5-52 X Case 5-53 X Case 5-53 X Case 5-54 X Case 5-55 X Case 5-56 X Section 6 Case 6-1 Case 6-2 Case 6-3 Case 6-4 Case 6-5 Case 6-6 Case 6-7 Case 6-8 Case 6-9 Case 6-10 Case 6-11 Case 6-12 Case 6-13 Case 6-14 Case 6-15 Case 6-16
X X
X X
X
X X
X
X
X X X X X X X X X X X X X X X X
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Instructor Manual to Accompany Case Studies in Health Information Management xxv
Case Study Crosswalk for Baccalaureate Degree Curriculum Competencies (continued) Domain 1 Domain 2 Domain 3 Domain 4 Domain 5 Health Data Management
Case 6-17 Case 6-18 Case 6-20 Case 6-21 Case 6-22 Case 6-23 Case 6-24 Case 6-25 Case 6-26 Case 6-27 Case 6-28 Case 6-29 Section 7 Case 7-1 Case 7-2 Case 7-3 Case 7-4 Case 7-5 Case 7-6 Case 7-7 Case 7-8 Case 7-9 Case 7-10 Case 7-11 Case 7-12 Case 7-13 Case 7-14 Case 7-15 Case 7-16 Case 7-17 Case 7-18 Case 7-19 Case 7-20 Case 7-21 Case 7-22 Case 7-23 Case 7-24
Health Statistics, Biomedical Research, and Quality Management
Health Services Organization and Delivery
X X
X X
X
X
Information Technology and Systems
X
X X X X
X X X X
X X X X X
X
X
X X X X
X X X X X
X X
X X X X X X X X X
X
X X
X X X X
X
X
X
X
X
Organization and Management
X X X X X X X X X X X X
X X X X X X X X X X X X X X X X X X X X X X X X
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Instructor Manual to Accompany Case Studies in Health Information Management xxvi
Preface Instructor Manual How to Implement into Curriculum For the educators’ use in choosing appropriate case studies for their classes, we have included a table of competencies based on AHIMA Curriculum Competencies and Knowledge Clusters. Use the appropriate AHIMA Curriculum Map for assistance in choosing which course and level of taxonomy each case addresses. Refer to http://www.ahima.org/schools/FacResources/curriculum.aspx To assist the instructor in using cases, this instructor manual also contains answer keys, rationales, and references. For continuity, when a table or figure appears in the instructor manual as well as the case study book, it has the same title. If a table or figure is only in the instructor manual, it is titled by the section and case and given an alphabetic letter. For example, in Section 2 Case 26, a figure containing a sample appeal letter that is in the instructor manual (not in the case study book) is titled Figure 2-26A. When using websites for references, the URL is presented first, and then the specific address where the information was accessed is given. Although these secondary addresses may have changed from the date they were accessed, hopefully using them and having the main website address will assist you in finding the materials.
Introduction These Health Information Management case studies have been developed to provide the student with an opportunity to experience a wide range of HIM situations. They give the students a chance to utilize the HIM principles in making decisions based on multiple variables. The case format can help the student move from theory to application and analysis. Using the book with this instructor manual provides instructors with a transitional tool to help guide students in “bridging the gap” between content knowledge and on-the-job performance in actual HIM practice. Critical thinking is a cornerstone to HIM practice. These case studies were designed to assist students of all levels in developing and strengthening their critical thinking skills. The case studies give the students a chance to utilize HIM principles in making decisions based on a changing HIM work field with multiple variables. Each case brings the user into the HIM setting and invites him or her to utilize HIM processes while considering all of the variables that influence the protected information management situation. The cases represent a unique set of variables to offer a breadth of learning experiences and to capture the reality of HIM practice. The students should not expect to be able to just look up the answers in the textbooks. They will have to draw on everything that they have learned in order to answer many of the questions in the case study. Suggestions to help guide the students have been provided in this instructor manual.
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Instructor Manual to Accompany Case Studies in Health Information Management xxvii
Organization of the Instructor Manual The cases are grouped into parts based on 7 major HIM topics: •
Health Data Management
•
Clinical Classification Systems and Reimbursement Methods
•
Statistics and Quality Improvement
•
Healthcare Privacy, Confidentiality, Legal, and Ethical Issues
•
Information Technology and Systems
•
Management and Health Information Services
•
Project and Operations Management
Although reimbursement issues and coding go hand in hand, we have not included a variety of coding questions since there are a myriad of excellent coding texts and workbooks. Our focus is on principles and compliance rather than on specific codes. Within each part, cases are organized by subject area and then from less difficult to more difficult. The classification of the cases is subjective and, as we all know, many of the HIM principles pertain to more than 1 HIM topic. Of course, no instructor manual can be complete in providing everything that would be helpful in using the textbook it supports. This certainly is applicable to the case study responses presented within this text. The authors of this text have made a concentrated effort to assist instructors who would make use of it. Instructors and participants who work the case studies presented are encouraged to expand and improve upon these responses or to develop more on their own.
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
SECTION ONE Health Data Management
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Section 1 Health Data Management 2
CASE 1-1 Subjective, Objective, Assessment, and Plan (SOAP) Statements and the ProblemOriented Medical Record (POMR)
Questions and Suggested Answers Determine whether each statement is a subjective (S), objective (O), assessment (A), or plan (P) entry from the patient records. 1. __P__ Rule out myocardial infarction. 2. __S__ Patient complains of pain in the left ear and upon neck movement. 3. __O__ BP 130/80. Pulse 85. Respiration 20. Temperature 98.6F. Lungs clear. Heart regular. Abdomen nontender. 4. __P__ Compare baseline mammogram from 2006 to current mammogram. 5. __A__ Uncontrolled hypertension. 6. __S__ Chest pain. 7. __O__ Pedal edema was 2+. 8. __A__ Possible aortic aneurysm. 9. __P_ Rule out cancerous tumor following biopsy of thyroid lesion. 10. __S__ Patient complained of headache, fatigue, and photosensitivity. 11. __S__ Patient states, “I am thirsty all the time.” 12. __P__ Discharge home with home health nursing and durable medical equipment. Followup in 1 week with Dr. Brantley. Home medications of Plavix 75 mg, Zetia 10 mg, Norvasc 25 mg, and Tricor 145 mg. 13. __O__ BUN 21.0 mg/dL, ALB 6.0 g/dL, bilirubin total 6.3 mg/dL. 14. __O__ Percussion was normal. 15. __A__ MRI brain with and without contrast: negative findings. 16. __S__ Complaining of pain in the low back. 17. __A__ Chest x-ray: negative. EKG: A-fibrillation. Total LDH: 145. 18. __O__ Laceration measured 2 cm above right brow. 19. __P__ Determine treatment following results of radiology studies. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 1 Health Data Management 3
20. __A__ Surgical Pathology Frozen Section: Lung LLL Wedge Biopsy reflects non–small cell carcinoma involving pleural nodule.
References Green and Bowie LaTour and Eichenwald-Maki
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 1 Health Data Management 4
CASE 1-2 Problem-Oriented Medical Record (POMR) Format
Questions and Suggested Answers 1. What is the patient’s chief complaint? Severe pain in the left hip. 2. What information in the scenario is “subjective”? Severe pain in left hip sustained from fall out of wheelchair. 3. What information in the scenario is “objective”? Intertrochanteric fracture of the left hip, shortening of left leg, and good bilateral pedal pulses prior to surgery. After surgery there was diffuse osteopenia and near alignment of intertrochanteric femoral neck. 4. Does Dr. Jenkins have a definitive assessment of Ms. Gerry’s problem? Prior to surgery, the patient was diagnosed with fracture of left intertrochanteric hip. 5. What is the plan for this patient? Vitamin K to decrease protime, Bucks traction, and open reduction with internal fixation of left hip upon receipt of a medical clearance.
References Green and Bowie LaTour and Eichenwald-Maki
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 1 Health Data Management 5
CASE 1-3 Master Patient Index (MPI) and Duplicate Medical Record Number Assignment
Questions and Suggested Answers 1. For each pair of patients listed, which medical record number should be retained based on the hospital policy? The survivorship number should be the MR# retained per policy. The original or initial MR# assigned would be the survivorship in each case: •
Case 1 is MR# 016793
•
Case 2 is MR# 019156
•
Case 3 is MR# 114682
•
Case 4 is MR# 015467
•
Case 5 is MR# 122199
•
Case 6 is MR# 098972
2. Which numbers listed do you think will require further documentation review to determine whether the patients are the same or not? Case numbers 3 and 5 will require further investigation to verify if they are the same patient. However, case numbers 2, 4, and 6 are unlikely the same patient. 3. Which record documentation or data elements from the patient record could be used for determining “matches” of same patient versus different patients? When the demographic data from the MPI are ambiguous, record documentation that includes signature from the patient or patient representatives, signature of the guarantor, or insurance policy and/or policy number should be used to validate if a patient match exist.
Reference LaTour and Eichenwald-Maki © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 1 Health Data Management 6
CASE 1-4 Enterprise MPI (E-MPI)
Questions and Suggested Answers 1. Level 1: Research the recommended core elements of a single-entity master patient index (MPI) and a multi-facility enterprise MPI through professional journals and list references used (e.g., Journal of AHIMA). Student could refer Journal of AHIMA practice brief. The core elements include Internal Patient Identifier, Person Name, Date of Birth, Gender, Race, Ethnicity, Address, Telephone Number, Alias/Previous/Maiden Name, SSN, Facility Identifier, Account/Visit Number, Admission/Encounter/Visit Date, Discharge or Departure Date, Encounter/Service Type, Encounter/Service Location, Encounter Primary Physician, and Patient Disposition. Additional recommended elements to the core elements exist for an enterprise MPI found in the article. 2. Level 2: Develop a data dictionary defining each of the data elements needed. A sample table of definitions is provided in Table 1-4A. 3. Level 3: Design a data display screen of a multi-facility enterprise MPI screen. A sample enterprise MPI (E-MPI) is shown in Figure 1-4A.
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 1 Health Data Management 7
Table 1-4A Definitions for Data Dictionary
Data Element
Definition
Data Format Type (with HL7 Abbreviation)
Enterprise ID#
Primary identifier used by the enterprise to identify the patient (Enterprise #)
Facility
Primary identifier used by the enterprise to
Identifier
identify facility (Facility Code)
Internal Patient
Primary identifier used by the facility to identify
Extended composite
Identification
patient admission (MR #)
ID with check digit (CX)
Person Name
Date of Birth
Legal name of patient, including suffixes (Doctor,
Extended person name
Father, Jr., III) and prefixes
(XPN)
Patient’s date of birth. Year, month, and day are
Time stamp (TS)
entered (e.g., YYYY, MM, DD). Essential that year is entered as four digits Gender
Gender of patient
Coded value in userdefined table (IS).
Race
Race of patient largely to identify on the basis of
Coded element (CE)
physical characteristics by descent (e.g., American, Indian/Eskimo/Aleut, Asian or Pacific Islander, Black, White, other, unknown) Ethnicity
Ethnicity of patient largely to identification on the
Coded element (CE)
basis of shared cultural characteristics or geographic origin (e.g., Hispanic, Non-Hispanic, unknown) Residence
Address or location of patient residence. Include
Extended address
street, apartment number, city, state or province,
(XAD)
ZIP, postal code, country, type address (mailing or permanent) © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 1 Health Data Management 8
Alias/Previous/
Any names patient has used other than the current
Extended person name
Maiden Name
legal name. Include nicknames, maiden, previous
(XPN)
Social Security
Personal identification number assigned by U.S.
String data (ST)
Number
Social Security Administration
Telephone
Telephone number at which the patient can be
Extended
Number
contacted. Include home, business, or friend
telecommunication number (XTN)
© 2014 Cengage Learning ®. All Rights Reserved.
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
© 2014 Cengage Learning ®. All Rights Reserved.
Section 1 Health Data Management 9
Figure 1-4A EMPI
Reference American Health Information Management Association (AHIMA) (2010)
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 1 Health Data Management 10
CASE 1-5 Chart Check-Out Screen Design and Data Quality
Questions and Suggested Answers Identify ways to improve data quality. •
Figure 1-2 has inefficient use of space.
•
Data fields should be sequenced with workflow and read horizontally on screen, from left to right.
•
Ensure data quality and data checks are built into the screen to capture the correct type of data and field width.
•
Utilize drop-down windows, check boxes, or radio buttons in capture of data (e.g., a drop-down box could be used for the location field to ensure that only valid locations could be entered).
•
Good operations management would allow a print option to give a slip (or list with multiple record request), indicating a due date for return in abidance with hospital policy.
•
Checked-out date chart could be assigned by the system automatically to prevent data entry errors and to save time.
•
Patient name should be automatically populated when the medical record number is entered.
•
The user should be recorded based on sign-on so there is no need for the initial field.
References Abdelhak Amatayakul Johns LaTour and Eichenwald-Maki Murphy Rhodes Williams © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 1 Health Data Management 11
CASE 1-6 Patient Demographic Data Entry Screen Design and Data Quality
Questions and Suggested Answers Identify ways to improve data quality. •
Figure 1-3 has inefficient use of space.
•
Data fields should be sequenced with workflow and read horizontally on screen, from left to right.
•
The hair color field should be dropped because it is irrelevant to the data being collected.
•
For normalization purposes, the city and state should be broken down into two separate fields. The state field could be a drop box from which the user could select the appropriate state. The state in which the facility is located should be the default. The city field could be populated by ZIP code.
•
The demographics captured on this field are very basic. There are additional demographic data elements that should be captured including, but not limited to, race, gender, religion, and phone number including area code.
•
Recommend field for date of birth (DOB) be added and to be sequenced with workflow in gathering patient information at time of registration.
•
Ensure that data quality and data checks are built into the capture of data type.
•
Utilize drop-down windows, check boxes, or radio buttons in capture of data (e.g., state).
References Abdelhak Amatayakul Johns © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 1 Health Data Management 12
LaTour and Eichenwald-Maki Murphy Rhodes Williams
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 1 Health Data Management 13
CASE 1-7 Encounter Abstract Screen Design and Data Quality
Questions and Suggested Answers Identify ways to improve data quality. •
Data elements requested in Figure 1-4 appear comprehensive enough; however, there is inadequate use of space.
•
Admission date could default to the day that the entry is being created but should allow the user to change the admission date in case the system is down and the user needs to enter admissions from the previous day.
•
Data fields should be sequenced with workflow and read horizontally on screen, from left to right.
•
Ensure that data quality and data checks are built into the capture of data type.
•
The default to the advanced directive field should be specified by the hospital policy. If the advanced directive is provided to the patient and the patient’s signature is obtained at each admission, then the default could be Yes. Otherwise, it would be No.
•
The data field requesting Notice of Privacy Practice Given needs to be repositioned with response radio buttons appearing either stacked vertically or aligned horizontally.
Utilize drop-down windows, check boxes, or radio buttons in capture of data. Examples of fields for using drop-down boxes are as follows: •
Admitting physician field should be a drop-down box.
•
The bed could be a drop-down list of all beds available for occupancy. The format could be changed so that instead of a very long list, the user could select the unit and then a list of available beds would appear.
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 1 Health Data Management 14
References Abdelhak Amatayakul Johns LaTour and Eichenwald-Maki Murphy Rhodes Williams
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 1 Health Data Management 15
CASE 1-8 Coding Abstract Data Entry Screen Design and Data Quality
Questions and Suggested Answers Identify ways to improve data quality. •
Data elements requested in Figure 1-5 appear comprehensive enough; however, there is inefficient use of space.
•
Data fields should be sequenced with workflow and read horizontally on screen, from left to right.
•
Ensure that data quality and data checks are built into the capture of data type.
•
Utilize drop-down windows, check boxes, or radio buttons in capture of data.
•
The patient name should appear automatically via an interface with the hospital information system.
•
There should be a way to select a particular patient visit so that you can assign the appropriate diagnosis and procedure codes. Currently, you only enter the patient’s name and number.
•
The procedure fields, the surgeon field, as well as the date of surgery are missing.
•
The admitting diagnosis field is missing.
•
The codes should be checked to ensure that they are valid.
References Abdelhak Amatayakul Johns LaTour and Eichenwald-Maki Murphy Rhodes Williams © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 1 Health Data Management 16
CASE 1-9 Designing a Report for Radiology and Imaging Service Examinations
Questions and Suggested Answers Develop a requisition and imaging report to be used for radiology and imaging service exams. The students should employ good design principles for the form design by •
including a form title and identifying organization name and address,
•
having a consistent organized format,
•
reflecting a form number,
•
reflecting a review/approval date,
•
reflecting clear data fields with boxed field names in a smaller font,
•
organizing sections utilizing line separation or boxed sections,
•
considering color bars for emphasis, and
•
allowing adequate spacing for any required written authorization by the interpreting radiologist (physician).
Have each student or teams of students create the form, and then critique each of the forms created as a class.
References Johns LaTour and Eichenwald-Maki
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 1 Health Data Management 17
CASE 1-10 Documentation Requirements for the History and Physical Report
Questions and Suggested Answers Research the Joint Commission, Centers for Medicare and Medicaid Services (CMS), and Det Norske Veritas (DNV) standards for the history and physical report form to discover the differences in requirements. Create a table showing the differences between Joint Commission standards and the Conditions of Participation (COP) with CMS and the DNV. Table 1-10A shows a sample of the differences in requirements.
Table 1-10A Differences in Requirements for the History and Physical Report Joint Commission Standard
CMS COP Standard
DNV Standard
History and physical (H&P)
An H&P must be performed
A complete H&P must be
must be performed and
no more than 7 days prior to
documented 24 hours after
documented in the patient
admission or within 48 hours
admission or no more than 7
record within 24 hours after
after admission.
days before admission and
admission as an acute care
filed in the patient’s record
hospital inpatient.
within 48 hours after admission.
If an H&P was completed within 30 days prior to admission and reviewed and updated, it may be placed on the record within 24 hours after admission. © 2014 Cengage Learning ®. All Rights Reserved.
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Section 1 Health Data Management 18
References Green and Bowie Joint Commission (n.d. 2) LaTour and Eichenwald-Maki, Appendix
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Section 1 Health Data Management 19
CASE 1-11 Documentation Requirements for the Autopsy Report
Questions and Suggested Answers Research the documentation requirements of the Joint Commission and the DNV for the autopsy report documentation. Create a table to report the differences in requirements. Table 1-11A is a sample table of the differences in documentation requirements.
Table 1-11A Differences in Requirements for the Autopsy Report
Joint Commission Standards
DNV Standards
Provisional anatomic diagnosis is to be
The autopsy report must include a report of gross
documented in the patient record within 72
and microscopic findings; gross findings
hours after autopsy is performed. The
completed and documented on the record within
complete autopsy protocol is to be made
15 days of autopsy; microscopic findings
part of the permanent record within 60
completed and documented on the record within
days after completion.
30 days of autopsy; and toxicology reports documented on the record within 6 months.
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Reference Green and Bowie
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Section 1 Health Data Management 20
CASE 1-12 Data Collection in Long-Term Care: Minimum Data Set Version 3.0 (MDS 3.0)
Questions and Suggested Answers 1. Level 1: For informational purposes, visit the CMS website for “MDS 3.0 training.” Review the official MDS and provide the following information: a) MDS 3.0 required data sections. The MDS 3.0 is a standardized data set used in long-term care containing sections labeled A to Q, V, X, and Z for reporting to Centers for Medicare and Medicaid Services (CMS). It is important to note that data sections do not exist for R–U, W, and Y. The MDS 3.0 requires collection of various types of data utilizing the resident assessment instrument (RAI). b) The types of data included under each section. Data are collected on each patient utilizing the RAI and appropriate coding convention for administrative, clinical, and patient-specific data. The types of data found under each section include A = Identification Information, B = Hearing, Speech, and Vision, C = Cognitive Patterns, D = Mood, E = Behavior, F = Preferences for Customary Routine and Activities, G = Functional Status, H = Bladder and Bowel, I = Active Disease Diagnosis, J = Health Conditions, K = Swallowing/Nutritional Status, L = Oral/Dental Status, M = Skin Conditions, N = Medications, O = Special Treatment and Procedures, P = Restraints, Q = Participation in Assessment and Goal Setting, V = Care Area Assessment Summary, X = Correction Request, and Z = Assessment Administration. c) Where in the medical record you would expect to find the data to complete each section of the MDS? The MDS data are relatively comprehensive and will require a review of the entire medical record for collection of data of many sections and resident and/or family interview for other sections in the MDS 3.0. The suggested reports within the medical record where data may be found in completing various sections of the MDS 3.0 are given in the following. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 1 Health Data Management 21
Section Title Section A
Identification Information
Medical Record Form Admission record (facesheet) and/or social assessment
Section B
Hearing, Speech, and Vision
Nurses assessment
Section C
Cognitive Patterns
Structured cognitive test or interview
Section D
Mood
Staff review of resident mood indicators, and/or staff mood interview
Section E
Behavior
Psychosocial assessment and/or social notes
Section F
Preferences for Customary
Direct from resident, family, or staff
Routine and Activities
interviews
Functional Status
Nurses assessment, nurses notes, and/or
Section G
therapist notes Section H
Bladder and Bowel
Nurses notes
Section I
Active Disease Diagnosis
History and physical and/or physician progress notes
Section J
Health Conditions
Resident interview preferable and/or nurses notes or physician progress notes
Section K
Swallowing/Nutritional Status
Dietary assessment, nurses assessment, and/or dental assessment
Section L
Oral/Dental Status
Dietary assessment, nurses assessment, and/or dental assessment
Section M
Skin Conditions
Nurses assessment, treatment record, and/or skin assessment
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Section 1 Health Data Management 22
Section N
Medications
Physician orders and medication administration record
Section O
Section P
Special Treatments and
Therapist assessment, dietary, and/or
Procedures
restorative assessment
Restraints
Physician orders, nurses notes, and/or restraint record
Section Q
Section V
Section X
Participation in Assessment
Resident interview, discharge planning, and
and Goal Setting
interdisciplinary care plan
Care Area Assessment
Discharge planning and interdisciplinary care
Summary
plan
Correction Request
Only for correcting erroneous MDS items previously reported/transmitted to national MDS database.
Section Z
Assessment Administration
Admission record
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2. Level 2: Listen to the online panel discussion “MDS 3 Interdisciplinary Team” to assist in answering the following questions: a) Which MDS 3.0 section requires using the resident’s medical record for completion? The sections requiring the medical record would include A, B, E, G, H, I, K, L, M, N, O, P, V, and Z. Section A (ID Information), Section B (Hearing, Speech, and Vision), Section E (Behavior), Section G (Functional Status), Section H (Bladder and Bowel), Section I (Active Disease Diagnosis), Section K (Swallowing/Nutritional Status), Section L (Oral/Dental Status), Section M (Skin Conditions), Section N (Medications), Section O (Special Treatments and Procedures), Section P (Restraints), Section V (Care Area Assessment Summary), and Section Z (Assessment Administration). © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 1 Health Data Management 23
b) What problems are likely to be encountered while completing the MDS 3.0? Problems which may be incurred include falsification or inaccuracy of documentation due to lack of staff knowledge in using correct coding convention of data elements pertinent to the MDS sections. c) What suggestions would you make to overcome these problems? Suggestions to overcome identified problems include repeated training of staff in correct coding and completion of the various sections throughout the MDS. Provide training on conducting interviews correctly with residents and/or family that focus on the resident’s needs.
3. Level 3: Listen to the CMS presentation “VIVE: Video on Interviewing Vulnerable Elders” to assist in answering the following questions. a) What sections of MDS 3.0 must be completed by interview? Sections requiring completion by interview technique include C, D, F, and J. These sections are Cognitive Patterns (C), Mood (D), Preferences for Customary Routine and Activities (F), and Health Conditions (J). b) What are the advantages of using an interview format for gathering this data? Advantages are to improve assessment of resident in establishing higher quality of care to meet the resident’s needs. c) How long do these interviews typically take, according to the training video? The average time for interviews is approximately 17 minutes. d) Describe some of the techniques suggested for the interview process. Techniques for the interview format include using external listening agent or amplifier, arranging a quite private setting, establishing a good rapport and comfort with resident, establishing comfortable seating distance in front of the resident, assuring proper lighting, assuring comfortable room temperature, and ensuring clearly visible font Que Card when visual aids are used.
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Section 1 Health Data Management 24
References Centers for Medicare and Medicaid Services (2002). Minimum data set version 3.0 (MDS 3.0) http://cms.hhs.gov LaTour and Eichenwald-Maki
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Section 1 Health Data Management 25
CASE 1-13 Data Collection for the Health Plan Employer Data and Information Set (HEDIS) in Managed Care
Questions and Suggested Answers 1. Develop a list of the care measures tracked among different patient populations. Review NCQAs report on “The State of Health Care Quality 2011: Continuous Improvement and the Expansion of Quality Measurement.” Safety and potential waste measures should include the following: •
Avoidance of antibiotic treatment for acute bronchitis in adults
•
Use of imaging studies for low-back pain
Wellness and prevention measures should include the following: •
Adult BMI assessment
•
Flu shots
•
Cancer screenings including breast, cervical, and colorectal
•
Smoking and tobacco cessation
Chronic disease management measures might include the following: •
Beta blocker treatment after heart attack
•
Comprehensive diabetic care
•
Controlling high blood pressure
•
Managing cholesterol in cardiovascular patients
•
Anti-rheumatic drug therapy for rheumatoid arthritis
•
Medication treatment for asthma
•
COPD patient assessment with spirometry testing
•
Pharmacotherapy management of COPD exacerbation
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Section 1 Health Data Management 26
•
Antidepressant medication management.
Children and adolescent measures might include the following: •
Upper respiratory infection treatment
•
Lead screening
•
Chlamydia screening
•
Prenatal and postpartum care
•
Mental illness follow-up after hospitalization
•
Follow-up to ADHD medication treatment
•
Childhood and adolescent immunizations
Older adult measures might include the following: •
Fall risk management
•
Medication management
•
Urinary incontinence
•
Physical activity
•
Glaucoma
•
Osteoporosis testing, and osteoporosis management in women who have had fractures
2. Develop a summary of the patient populations reviewed and report findings relative to different conditions. The summary should reflect chronic disease management, children and adolescents, and older adults. •
Answers will vary among the students depending on patient population and condition selected to report on. The instructor may indicate the number of conditions or specific patient population to report on.
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Section 1 Health Data Management 27
Reference National Committee for Quality Assurance (NCQA)
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Section 1 Health Data Management 28
CASE 1-14 Birth Certificate Reporting Project
Questions and Suggested Answers Use the information in the interview with the mother and abstract information from the obstetric record to complete the birth certificate form shown in Figure 1-14A.
References Green and Bowie Johns LaTour and Eichenwald-Maki
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Section 1 Health Data Management 29
Figure 1-14A Manual Birth Certificate
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Section 1 Health Data Management 30
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Section 1 Health Data Management 31
CASE 1-15 Clinical Coding Systems and Technology
Questions and Suggested Answers Compare and contrast how each might be used differently. Summarize your analysis, stating which technology you feel is most advantageous and why. Include reference sources you utilized in your analysis. •
Natural language processing (NLP) technology uses complex algorithms that read data already entered into an electronic health record (EHR) to assign the codes automatically. The NLP uses computational linguistics, including linguistics, semantics, and computer science.
•
The CAC will provide technological assistance in proper assignment of codes. The CAC system provides software that will automatically assign a set of medical codes.
•
The coder role will review the accuracy of the code for validation in either the NLP or CAC. Both categories of technology could be used to improve accuracy and consistency of code assignments. They also reduce the risk of fraud with the Office of Inspector General (OIG) from erroneous code assignments.
•
The student’s summary will vary depending on which system they feel is more advantageous.
This information comes from the AHIMA website at www.ahima.org.
References American Health Information Management Association (AHIMA) (July, 2010) LaTour and Eichenwald-Maki
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Section 1 Health Data Management 32
CASE 1-16 External Administrative Requirements: ORYX™ Performance Measures for the Joint Commission and CMS
Questions and Suggested Answers 1. What have been the ORYX™ performance measure requirements in the past for hospitals? Acute MI, heart failure, community-acquired pneumonia, and pregnancy and related conditions. Search the Joint Commission website at http://www.jointcommission.org for performance measurement initiatives. 2. Explain how ORYX™ and performance measure data are used in the accreditation process. Surveyors receive a summary of the hospital’s performance on core measures collected and reported by the hospital prior to survey. Through a data-driven survey, known as priority focus process, the core measurement results, along with other pre-survey data inputs, are used to guide the on-site survey process. Search the Joint Commission website at http://www.jointcommission.org for a Joint Commission Accreditation process: Facts about the priority focus process.
References Joint Commission (n.d. 1 and n.d 3) LaTour and Eichenwald-Maki
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Section 1 Health Data Management 33
CASE 1-17 Joint Commission Mock Survey
Questions and Suggested Answers What suggestions would you include in the next mock survey conducted? Some suggested activities for a mock on-site survey include: The format of an actual on-site survey will be structured to include the following bullet points. The mock survey could be formatted to simulate the entire survey process with these key components. However, the opening conference and leadership session would involve various management staff inclusive of the c-suite and departmental directors. •
An initial survey planning session
•
Opening conference and orientation
•
Leadership session
•
System/Individual tracers conducted
•
Competence assessment process
•
Building tour and environment of care session
•
Exit conference
1. Patient (aka individual) tracers could be conducted from different points of care for selected patients. The surveyor might pick up a patient in the emergency department and follow the care and treatment forward through the care process. A similar patient tracer could be conducted of a patient selected after his or her episode of care has begun whereby he or she is already placed in a patient room, so the care is traced backward through the care process. Remember that selected cases often are based on the organization’s most represented patient population and data collected via ORYX™ core measure reporting. 2. The administrator surveyor could give the HIM director the Medical Records Statistic Report to complete the past 12 months of delinquent record statistics. 3. A system tracer could be performed on the medication administration system whereby the surveyor observes and interviews staff in their performance of entering orders into the © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 1 Health Data Management 34
medications order entry information system; the pharmacy’s receipt and dispensing of the order; and the medication nurse during the administration of the medications. Another system tracer may include an infection control tracer. 4. The Communication of National Patient Safety Goals (NPSGs) could be surveyed through a review of in-house patient records to validate that there have not been unacceptable abbreviations, acronyms, or symbols documented in the patient records. Additional elements can be reviewed to ascertain that •
verbal orders (VOs) and reporting of critical test results reflect that the authorized transcriber (i.e., nurse, therapist) is being documented; and
•
the care provider (transcribed) heard and “read back” the complete order or test result accurately and that it is documented accordingly in the patient record.
References Johns Joint Commission (n.d.3) McWay
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Section 1 Health Data Management 35
CASE 1-18 Authentication Compliance
Questions and Suggested Answers Students should research the topic for Joint Commission authentication requirements of medical record documentation to report to the Accreditation Committee Meeting and the Federal Register COP for Medical Record Services. The student response may include that all medical reports in the patient record require completion with authentication. The timeframe will differ by report in order to meet JC and COP requirements. However, all orders, including verbal orders, must be legible, dated, timed, and authenticated by the ordering physician or another practitioner responsible for the care of the patient; and who is authorized to write orders by policy in accordance with their state law. In the absence of a state law designation of an authentication timeframe, all verbal orders must be authenticated within 48 hours. Federal and state laws specify how an electronic authentication is acceptable via a computergenerated code.
References GPO Code of Federal Regulations Joint Commission (n.d. 4).
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 1 Health Data Management 36
CASE 1-19 Primary Ambulatory Care Center EHR and Meaningful Use
Questions and Suggested Answers What major elements do you need to consider in the project to propose a selected EHR system and become a meaningful user? The student response may include Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted in 2009 through the ARRA and introduced the meaningful use (MU) concept. The ultimate goal of MU is to improve clinical outcomes and interoperability of the electronic health record. Understand that MU is implemented in 3 stages. The year MU stage 1 starts determines the reporting requirements for subsequent stages. The goals of MU are separated into 5 categories to leverage electronic health information in connecting patients to their health status: •
Improve quality, safety, efficiency, and reduce health disparities
•
Engage patients and families in their health care
•
Improve care coordination
•
Ensure adequate privacy and security protections for personal health information
•
Improve population and public health
Major components the student might recommend in the proposed projects are as follows: 1. Research and acquire 3 requests for proposals (RFP) from “certified” EHR vendor systems for review and selection of a system. 2. Develop a steering committee, represented by a physician, clinician, billing, IT, and HIM staff to assess and establish the desired functionality in their EHR system. 3. Establish a project timeline of acquiring a certified EHR, implementing, training physicians and staff, conducting self-assessment of meeting MU Core Set/Menu objectives, clinical quality measures (CQMs), and menu set objectives as a provider, and submission of “Attestation” to MU requirements. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 1 Health Data Management 37
References Centers for Medicare and Medicaid Services (n.d.)
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Section 1 Health Data Management 38
CASE 1-20 Case Finding for Tumor Registry
Questions and Suggested Answers What are your sources for obtaining the information to compile a list? Diagnosis registries are used for the “case definition” process to screen all bladder and colon cancer code ranges from the ICD-9 or ICD-10 code systems. The applicable code system would be based on the time period the COO is requesting cases from. Should the period overlap during transition of ICD-9 to ICD-10 code system, GEMs mapping may be used as a crosswalk to find appropriate cancers? After the case definition has been identified for applicable code ranges, the data must be extracted through “case finding” of patients seen and treated at the county hospital via outpatient and inpatient services. The report should be developed in a spreadsheet to include demographic identifier fields of resident zip code, city and county origins to allow various means of manipulating and reporting data. Also, cases may be identified through a review of pathology reports completed during the 6 months requested.
References Abdelhak Johns LaTour and Eichenwald-Maki
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Section 1 Health Data Management 39
CASE 1-21 Face Validity of QI Study on Births
Questions and Suggested Answers 1. How many patients are primigravida? 4 reflected having first (G) gravida pregnancy. 2. How many total pregnancies have these 17 patients had? Total 42 reflected pregnancies. 3. How many full-term births are reported? There were 18 reflected (T) term births. 4. How many premature births are reported? There were 4 reflected (P) para preterm births. 5. How many aborted pregnancies are reported? There were 4 reflected (A) aborted pregnancies. 6. How many living children are reported? There were 20 reflected (L) living children.
References Abdelhak Johns LaTour and Eichenwald-Maki
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Section 1 Health Data Management 40
CASE 1-22 Reproductive History Interpretation
Questions and Suggested Answers Explain patient reproductive histories at the time of their admission. MR # 050309—The patient’s reproductive history reflects GTPAL of 2-1-0-0-1, implying she has experienced 2 pregnancies, carried 1 full-term birth, had no preterm births, had no abortions, and has 1 living child as of her July admission. MR# 047738—The patient’s reproductive history reflects GTPAL of 4-2-1-0-2, implying she has experienced 4 pregnancies, carried 2 full-term births, had 1 preterm birth, had no abortions, and has 2 living children as of her July admission. MR# 050185—The patient’s reproductive history reflects GTPAL of 2-1-0-1-0, implying she has experienced 2 pregnancies, carried 1 full-term birth, had no preterm births, had 1 abortion, and has no living children as of her July admission.
References Abdelhak Johns LaTour and Eichenwald-Maki
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Section 1 Health Data Management 41
CASE 1-23 Abstract of Pertinent Inpatient Medical Documentation
Questions and Suggested Answers 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16.
Patient demographic data—Registration Record (aka, Face sheet) Evidence that the patient was informed of benefits, risks, and alternatives prior to a particular surgery—Informed Consent Reason for admission and review of body systems—History & Physical An evaluation of patient prior to induction of anesthesia—Pre-anesthesia Evaluation Chest radiology interpretation—Radiology Report (aka, x-ray) Name of surgeon and assistant surgeon, and estimated blood loss—Operative Report Family and social history—History CBC and urinalysis test results—Laboratory Reports Course of events throughout hospital stay—Discharge Summary (aka, Death Summary in event of death) Vital signs; fluid input and urine output—Graphics or Flowsheets Chronological entries made about patient’s condition by nurses—Nurses Progress Notes Chronological entries made about patient’s condition by physician—Physician Progress Notes Patient’s blood type and Rh factor—Blood Type and Crosshatch Report Discharge diagnosis and discharge instructions with follow-up care—Discharge Summary Date, time, name of drug; drug dose and route of administration—Medication Administration Record Name of person designated by patient to make healthcare decisions should patient become incapacitated—perhaps by having a Healthcare Proxy or Durable Power of Attorney for Healthcare
References Abdelhak Johns LaTour and Eichenwald-Maki
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Section 1 Health Data Management 42
CASE 1-24 Choosing a Personal Health Record (PHR)
Questions and Suggested Answers 1. What benefits would you expect to encounter when you implement your PHR? This depends on the system, but some expected responses would be the following: •
Internet accessibility
•
Improvement in quality of care
•
Accessibility in the event of a disaster
•
24/7/365 accessibility
2. What other information might the patient want to know? The students could come up with some of the following: •
Who is the provider of the PHR?
•
Is it comprehensive?
•
Who owns the PHR?
•
Is the information portable?
•
How is the information populated?
References American Health Information Management Association (AHIMA) (n.d. 1). American Health Information Management Association (AHIMA) (n.d. 2) Johns McWay
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Section 1 Health Data Management 43
CASE 1-25 Personal Health Record (PHR) Education
Questions and Suggested Answers Create the PHR information sheet. The student is to write a one-page information sheet that defines the PHR, explains the benefits of the PHR, and tells about the PHR that your facility is offering. With the PHR, patients will have access to test results, key clinical findings, and a secure e-mail to communicate with their doctors.
Reference American Health Information Management Association (AHIMA) (n.d. 2)
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Section 1 Health Data Management 44
References Abdelhak, M., Grostick, S., Hanken, M.A., & Jacobs, E. (Eds.). (2012). Health information: Management of a strategic resource (3rd ed.). Philadelphia: W. B. Saunders. American Health Information Management Association (AHIMA) (n.d. 1). Practice brief. The role or the personal health record in the EHR (updated). http://library.ahima.org/ American Health Information Management Association (AHIMA) (n.d. 2). myPHR. Retrieved October 18, 2012, from http://www.myphr.com/ American Health Information Management Association (AHIMA) (July 2, 2010). FORE BoK. Coding workflow and CAC practice guidance. Practice brief. Journal of AHIMA. Retrieved October 18, 2012, from http://www.ahima.org/resources/bok.aspx American Health Information Management Association (AHIMA). (2010). Practice brief. Fundamentals for building a master patient index/enterprise master patient index (updated). Retrieved October 18, 2012, from http://www.ahima.org/resources/bok.aspx; http://library.ahima.org/xpedio/idcplg? IdcService=GET_HIGHLIGHT_INFO&QueryText=%28MPI+Task+Force%29++%3cAND%3 e++%28xPublishSite%3csubstring%3e%60BoK%60%29&SortField=xPubDate&SortOrder=D esc&dDocName=bok1_048389&HighlightType=HtmlHighlight&dWebExtension=hcsp Amatayakul, M. (2009). Electronic health records: A practical guide for professionals and organizations (4th ed.). Chicago: AHIMA. Centers for Medicare and Medicaid Services (n.d.). Accessed June 16, 2013 from: www.cms.gov//EHRincentiveprograms
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
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Centers for Medicare and Medicaid Services. (2002). Minimum data set version 2.0 (MDS 2.0). Accessed June 16, 2013 from http://www.cms.gov/Medicare/Quality-Initiatives-PatientAssessment-Instruments/NursingHomeQualityInits/downloads/MDS20MDSAllForms.pdf Green, M., & Bowie, M. (2011). Essentials of health information management (2nd ed.). Clifton Park, NY: Thomson Delmar Learning. GPO Code of Federal Regulations. Accessed June 16, 2013 from http://www.gpo.gov/fdsys/pkg/ CFR-2011-title42-vol5/xml/CFR-2011-title42-vol5-part482.xml#seqnum482.24 Joint Commission (n.d. 1). Facts about ORYX™ for hospitals (national hospital quality measures). Accessed June 16, 2013 from: http://www.jointcommission.org/assets/1/18/Facts_ORYX_ for_Hospitals.pdf Joint Commission (n.d. 2). Specifications manual for joint commission national quality measures (V2012B). Accessed June 16, 2013, from http://manual.jointcommission.org/releases /TJC2012B/DataDictionaryIntroductionTJC.html#AlphaDataElementList Joint Commission (n.d. 3). Accreditation process overview. Retrieved June 13, 2013, from http://www.jointcommission.org/accreditation_process_overview/ Joint Commission (n.d. 4). FAQ page. Retrieved June 14, 2013, from http://www.joint commission.org/about/JointCommissionFaqs.aspx Johns, M. (Ed.). (2011). Health information management technology: An applied approach (3rd ed.). Chicago: AHIMA. LaTour, K., & Eichenwald-Maki, S. (Eds.). (2011). Health information management concepts, principles, and practice (3rd ed.). Chicago: AHIMA. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 1 Health Data Management 46
McWay, D. C. (2014). Today’s health information management: An integrated approach (2nd ed.). Clifton Park, NY: Cengage Learning. Murphy, G. F., Hanken, M. A., & Waters, K. A. (1999). Electronic health records: Changing the vision. Philadelphia: W. B. Saunders. National Committee for Quality Assurance (NCQA). The state of health care quality 2006: Executive summary. Retrieved October 18, 2012, from http://www.ncqa.org/Portals/0/ Publications/Resource%20Library/SOHC/SOHC%202011-v2-web_2.22.12.pdf Rhodes, H. (1997, March). AHIMA practice brief: Developing information capture tools. Journal of AHIMA, 68(3), 49–51. Retrieved October 18, 2012, from http://library.ahima.org/xpedio/ idcplg?IdcService=GET_HIGHLIGHT_INFO&QueryText=%28Developing+information+capt ure+tools%29%3cand%3e%28xPublishSite%3csubstring%3e%60BoK%60%29&SortField=xP ubDate&SortOrder=Desc&dDocName=bok1_000086&HighlightType=HtmlHighlight&dWebE xtension=hcsp Williams, A. (2006). Design for better data: How software and users interact onscreen matters to data quality. Journal of AHIMA, 77(2), 56–60. Retrieved October 18, 2012, from http:// multimedia.3m.com/mws/mediawebserver?7777771amfi7oYv7HYv77VGyGFRuuuuT-
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Section2 Clinical Classification Systems and Reimbursement Methods 47
SECTION TWO Clinical Classification Systems and Reimbursement Methods
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Section 2 Clinical Classification Systems and Reimbursement Methods 48
CASE 2-1 Official Coding Resource
Questions and Suggested Answers Help your new coder identify which official coding reference can help in assigning the proper codes to the diagnoses and procedures listed in Table 2-1.
The proper code(s) and the reference for each of the diagnoses or procedures are provided for each line item in Table 2-1.
Table 2-1 Coding Resources for Diagnosis and/or Procedure
Coding Resources for Diagnosis and/or Procedure Diagnosis and/or Procedure
Proper Code According to Official Coding Resources
Uvulopalatoplasty—laser assisted
CPT Assistant, 12/2004, page 19—42145
Tangent bone grafts
CPT Assistant, 2/2005, pages 14–15—22851
Needle aspiration of the intervertebral
Coding Clinic,2005,3rd quarter, pages 13–80.39 and
disk using CT guidance
88.38
Vertebral stapling
Coding Clinic, 2004, 3rd quarter, pages 9–10— 78.49
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Section 2 Clinical Classification Systems and Reimbursement Methods 49
What other training issues should you address with your new coder? •
She needs to know what is expected of her with regard to productivity, quality, and specific tasks for which she is responsible.
•
Elizabeth should learn how to use all of the computer systems that she needs to do her job. This includes the encoder and the financial information system.
•
Elizabeth should be educated on the various coding policies such as when to bring the chart to the attention of the supervisor, how to query physicians, if charts can be coded without discharge summaries, and more.
•
She probably should be started with the easier charges and gradually given more difficult charts as her skills improve. Since Elizabeth is new to coding, there should be a 100% coding audit performed on her charts.
The case study does not state if the new coder is an inpatient coder, an outpatient coder, or both. Given that she is a new graduate, she is most likely an outpatient coder. She would probably start with ancillary charts, and then move to other outpatient services such as ER, cardiac rehab, and then outpatient surgery. It would take about a year for Elizabeth to be fully trained and ready to work independently. You may want to pair Elizabeth up with an experienced coder for a mentoring relationship. She may be more comfortable asking another coder questions than you as her supervisor. A supervisor would have lower expectations from Elizabeth than she would have of an experienced coder. These expectations would be both in the quality of work performed and the quantity of work.
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Section 2 Clinical Classification Systems and Reimbursement Methods 50
References American Hospital Association. Coding Clinic American Medical Association. CPT Assistant Schraffenberger
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Section 2 Clinical Classification Systems and Reimbursement Methods 51
CASE 2-2 Coding Quality in ICD-9-CM
Questions and Suggested Answers Perform a face-validity review of the cases shown in Table 2-2 to determine if any coding quality issues can be identified. Table 2-2 Worksheet for Identifying Coding Quality Problems Worksheet for Identifying Coding Quality Problems
Case 1
Principal Diagnosis: 041.4 E. Coli infection Secondary Diagnosis: 599.0 Urinary tract infection (UTI)
Problem(s) Identified: This is a sequencing problem. According to basic coding rules, the site of the infection should be primary and the organism secondary. Case 2
Infection
Problem(s) Identified: The diagnosis code for septicemia is a combination code so it includes both the diagnosis of septicemia and the staphylococcal organism. According to basic coding rules, the staphylococcal code is redundant and should not be coded. Case 3
Principal Diagnosis: 414.01 Coronary artery disease (CAD) Principal Procedure: 36.12 Coronary artery bypass graft (CABG) 2 vessel
Problem(s) Identified: The face-validity audit demonstrates that further investigation is needed. A heart lung bypass is used during the performance of a CABG. The operative report should be reviewed to see if a heart bypass machine was used or if the wrong procedure was coded.
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Section 2 Clinical Classification Systems and Reimbursement Methods 52
Case 4
Principal Diagnosis: 550.92 Bilateral inguinal hernia Principal Procedure: 53.14 Repair, bilateral inguinal hernia
Problem(s) Identified: None can be identified from a face-validity audit with the information provided. If there were secondary procedures, we would expect to see coding for the insertion of lead(s). Case 5
Principal Diagnosis: 402.90 Hypertensive heart disease Secondary Diagnosis: 401.9 Hypertension
Problem(s) Identified: Basic coding rules state that hypertensive heart disease includes hypertension, so Code 401.9 is not required. Case 6
Principal Diagnosis: 780.01 Coma Secondary Diagnosis: 191.9 Adenocarcinoma brain Secondary Diagnosis: M8104/3
Problem(s) Identified: None can be identified from a face-validity audit. Case 7
Principal Diagnosis: 850.0 Concussion Secondary Diagnosis: 784.0 Headache
Problem(s) Identified: Headache is a symptom of a concussion, so the symptom code is not required. Case 8
Principal Diagnosis: V58.11 Admission for chemotherapy Secondary Diagnosis: 174.9 Adenocarcinoma breast Secondary Diagnosis: M8140/3 Adenocarcinoma Principal Procedure: 99.25 Chemotherapy
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Section 2 Clinical Classification Systems and Reimbursement Methods 53
Problem(s) Identified: None can be identified from a face-validity audit. Case 9
Principal Diagnosis: 426.0 Atrioventricular block, complete Principal Procedure: 37.81 Initial insertion of permanent pacemaker
Problem(s) Identified: None can be identified from a face-validity audit. © 2014 Cengage Learning ®. All Rights Reserved.
References National Center for Health Statistics (NCHS) (n.d.2) Schraffenberger Sayles
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Section 2 Clinical Classification Systems and Reimbursement Methods 54
CASE 2-3 Documentation Support for Principal Diagnosis
Questions and Suggested Answers What would you tell Javier about each? See Table 2-3 for response to each. Table 2-3 Principal Diagnosis and Explanation
Principal Diagnosis and Explanation
Principal Diagnosis: Pneumonia Explanation: Look at the chest x-ray (CXR). It will show the diagnosis of pneumonia. Other indicators will be difficulty breathing, productive sputum, and respiratory therapy.
Principal Diagnosis: Septicemia Explanation: The white blood cells (WBCs) will be elevated. The patient will run a fever and typically have a positive blood culture.
Principal Diagnosis:Respiratory failure Explanation: The patient may be on a ventilator. The patient will have difficulty breathing, the CO2 will be elevated, and the O2 will be decreased. The values required to indicate respiratory failure are defined by coding rules.
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Section 2 Clinical Classification Systems and Reimbursement Methods 55
Principal Diagnosis: Congestive heart failure Explanation: This condition is identified by fluid retention. Congestive heart failure (CHF) is diagnosed on the CXR. The patient will be on Lasix or another diuretic.
Principal Diagnosis: Cholecystectomy with cholelithiasis Explanation: The patient will have abdominal pain. The ultrasound or magnetic resonance imaging (MRI) will show gallstones. The pathology report from the procedure will confirm the diagnosis.
Principal Diagnosis: Preeclampsia Explanation: This condition is seen in pregnant women who have hypertension, protein in the urine, and an excessive sudden weight gain. Treatment includes monitoring of vital signs and weight.
Principal Diagnosis: Thrombophlebitis Explanation: The patient would have painful swelling of leg along the vein and usually a fever. Treatment would include bed rest and anticoagulants.
Principal Diagnosis: Cerebrovascular accident (CVA) Explanation: The patient would have symptoms of CVA such as difficulty speaking or paralysis. The CT or MRI should show hemorrhage or infarction in the brain. © 2014 Cengage Learning ®. All Rights Reserved.
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Section 2 Clinical Classification Systems and Reimbursement Methods 56
References Hamann National Center for Health Statistics (NCHS) (n.d.2) Neighbors and Tannehill-Jones Schraffenberger
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Section 2 Clinical Classification Systems and Reimbursement Methods 57
CASE 2-4 Improving Coding Quality
Questions and Suggested Answers 1. What can you do to improve coding quality?
There are a number of things that the supervisor can do. •
You can get a cardiologist and a pulmonologist to speak on CABGs, respiratory failure, and heart catheterizations. The cardiologist can explain what is done during the procedures, and educate the coders on the attributes of the diseases related to CABGs, respiratory failure, and heart catheterizations. This physician can also explain the lab values, treatment, and terms used in the operative report—especially those that impact code assignment.
•
The cath lab supervisor can also be invited to speak to the coders. The cath lab supervisor can work with the coders to help them associate codes to the procedure being performed. The cath lab supervisor can explain the difference in right and left heart catheterizations, ventriculograms, arteriograms, stents, and other procedures performed in the cath lab. The cath lab supervisor can also develop case studies or purchase coding exercise books for the coders to work with.
•
You should conduct audits and the findings should be reviewed with the coders so that they know what mistakes they are making. Areas of particular concern could be audited on a prebill basis.
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Section 2 Clinical Classification Systems and Reimbursement Methods 58
•
There should also be strong policies and procedures to assist the coder with code assignment and compliance issues.
2. What role can the encoder play in coding quality? •
The encoder asks coders questions such as: “Is the procedure performed on a native artery or a graft, an aortocoronary artery or a mammary artery?”
•
The coders can enter notes that they can refer to.
•
The coders can access coding rules, Coding Clinic, CPT Assistant, test result normals, abbreviations, and other resources.
References Abdelhak et al. Castro and Layman LaTour et al. Sayles Schraffenberger
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Section 2 Clinical Classification Systems and Reimbursement Methods 59
CASE 2-5 Chargemaster Audit
Questions and Suggested Answers What problem(s) can you identify?
The student will have to look up the codes to see if there are any problems. •
All codes were corrected except for one. The correct code for the left heart catheterization, retrograde-percutaneous is 93510 not 93546. The rest of the codes are correct.
•
There are missing data elements of the chargemaster entries. In the audit, there should also be a general ledger key, a revenue code, insurance code mapping, and the activity date/status.
References Abdelhak et al. Castro and Layman American Medical Association (AMA). (2011) LaTour et al. Sayles Schraffenberger
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Section 2 Clinical Classification Systems and Reimbursement Methods 60
CASE 2-6 Chargemaster Maintenance
Questions and Suggested Answers What plan would you come up with?
A comprehensive review needs to be conducted. The review should include checking for currency of information as well as its comprehensiveness and compliance with reimbursement rules. •
Currency includes that the chargemaster contains only valid codes and that the departments understand the codes being used for their services.
•
Comprehensiveness ensures that charges in the system reflect the current practices of the departments involved.
•
Compliance would include a review for issues such as unbundling.
•
The audit would consist of departments looking at every line item to ensure that the codes, charges, and pricing consistency are all correct.
•
A committee should be created to get everyone involved and accountable for the chargemaster.
•
The departments using the chargemaster know their services better than the HIM assistant director and therefore should be involved. The team should include chief
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Section 2 Clinical Classification Systems and Reimbursement Methods 61
financial officer, the finance and billing departments, a member from each department that uses the chargemaster to charge for services rendered, coders, the compliance officer, and possibly an attorney. The HIM assistant director could be the project manager for this project because administration has given her the responsibility of the chargemaster. •
Because a single person had been doing the maintenance in the past, the people on the committee would need to be trained in issues such as why they are doing what they are doing, what to look for, and so on.
•
The chargemaster would need to be updated when errors or omissions are identified. The coder would need to work with the respective clinical departments regarding coding accuracy.
•
Chargemaster maintenance is an ongoing process. The committee may also want to create a formal policy and procedure for requesting changes to the process as new services are added or existing ones are deleted. This process should identify who has the authority to make changes and what kind of documentation should be retained.
References Abdelhak et al. Castro and Layman Drach et al.
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Section 2 Clinical Classification Systems and Reimbursement Methods 62
LaTour et al. Sayles Schraffenberger
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Section 2 Clinical Classification Systems and Reimbursement Methods 63
CASE 2-7 Selecting Coding Classification Systems
Questions and Suggested Answers How would you respond?
You would tell him that you cannot eliminate ICD-9-CM and CPT because they are the required data sets for reimbursement. Systematized Nomenclature of Medicine (SNOMED) is not a classification system but rather a clinical vocabulary. These two tools are not the same.
Although SNOMED will give you much more information, it can only be practically used as part of the electronic health record because of the comprehensiveness of the vocabulary.
References Abdelhak et al. Castro and Layman LaTour et al. Sayles Schraffenberger
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Section 2 Clinical Classification Systems and Reimbursement Methods 64
CASE 2-8 Presentation on ICD-10-CM and ICD-10-PCS
Questions and Suggested Answers Develop PowerPoint slides to be used for your lecture on ICD-10-CM and ICD-10-PCS.
A sample set of PowerPoint slides are provided in Figure 2-8A for the lecture.
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Section 2 Clinical Classification Systems and Reimbursement Methods 65
ICD-10 PowerPoint Slide 1
ICD-10 PowerPoint Slide 3
ICD-10 PowerPoint Slide 2
ICD-10 PowerPoint Slide 4
ICD-10 PowerPoint Slide 6 ICD-10 PowerPoint Slide 5
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Section 2 Clinical Classification Systems and Reimbursement Methods 66
ICD-10 PowerPoint Slide 7
ICD-10 PowerPoint Slide 8
ICD-10 PowerPoint Slide 9 ICD-10 PowerPoint Slide 10
ICD-10 PowerPoint Slide 11 ICD-10 PowerPoint Slide 12
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ICD-10 PowerPoint Slide 13
ICD-10 PowerPoint Slide 14
ICD-10 PowerPoint Slide 15
ICD-10 PowerPoint Slide 16
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Section 2 Clinical Classification Systems and Reimbursement Methods 67
Figure 2-8A ICD-10-CM PowerPoint Slides
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Section2 Clinical Classification Systems and Reimbursement Methods 68
References Channel Publishing Hazelwood and Venable LaTour et al. National Center for Health Statistics (NCHS) (n.d.1)
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Section 2 Clinical Classification Systems and Reimbursement Methods 69
CASE 2-9 Encoder Functional Requirements
Questions and Suggested Answers Your job is to identify which of these functions are mandatory and which are optional requirements for the system that you choose. Justify your classification for each functional requirement. Table 2-5 Encoder Functional Requirements
Response to Questionnaire Function
Mandatory or Optional and Justification
Ability to connect to master patient index
Mandatory—Justification: Data quality issue
(MPI) for demographic information download Ability to update codes each year when
Mandatory—Justification: Required for data quality
new codes come out
and compliance
Coding resources available online
Mandatory—Justification: Compliance issue
Ability to show estimated reimbursement
Mandatory—Justification: Assists coders when
for our facility
there are two principal diagnoses
Provides a list of charts not coded
Optional—Justification: Discharged Not Final Billed (DNFB) Report provides this information already
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Section 2 Clinical Classification Systems and Reimbursement Methods 70
Ability to enter code(s) directly
Mandatory—Entering codes directly for codes that are used frequently speeds the coding process
Ability to write notes
Mandatory—Justification: Assists coders in documenting policies, coding references, or other key information
Ability to transfer codes and other
Mandatory—Justification: Productivity and data
information back into hospital financial
quality and issue
system Ability to sort codes
Mandatory—Justification: Saves coders time in analyzing their sequencing options
Ability to create and print out physician
Optional—Justification: Currently have paper form
queries Ability to save codes when you are unable Mandatory—Justification: Allows coders to to complete the coding
complete work the next day without starting over again
Includes multiple groupers
Mandatory—Justification: This allows you to use groupers for Medicare for multiple years as well as other insurers
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Section 2 Clinical Classification Systems and Reimbursement Methods 71
References Abdelhak et al. LaTour et al. Sayles Schraffenberger
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Section 2 Clinical Classification Systems and Reimbursement Methods 72
CASE 2-10 Encoder Selection
Questions and Suggested Answers 1. How would you handle this situation?
You could suggest that the student would conduct a thorough investigation of the 2 products and why the coders chose the system that they did. The student would then make the decision for the coders. In the future, the student would suggest that any further system selections be conducted on a more formal basis to avoid this situation again.
2. What questions would you ask as part of the investigation?
Questions could include the following: •
Why did the coder vote for his or her respective choice?
•
Why did the coder not vote for the other system?
•
What are the costs of the system?
•
How do the 2 systems compare based on functionality?
•
What did the references have to say about the respective systems?
•
Do the functionalities of the system meet the requests for proposal (RFP) requirements?
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Section 2 Clinical Classification Systems and Reimbursement Methods 73
•
Do the systems meet the other RFP requirements with regard to stability of company, technical issues, and so on?
3. If price, quality of system, references, and other evaluations are relatively equal, which would you choose and why? The student could choose either. Based on the information that is available, the student’s selection would probably be based on the preference for automated codebook and logicbased systems. •
Justification for the automated codebook could include easy transition from codebook to encoder or quickness of locating code.
•
Justification for the logic-based system could be reminders for other diagnoses and procedures or ease of use.
References Abdelhak et al. LaTour et al. Sayles Schraffenberger
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Section 2 Clinical Classification Systems and Reimbursement Methods 74
CASE 2-11 Request for Information (RFI) on Encoder Systems
Questions and Suggested Answers The information in Table 2-6 would be based on the information on the vendor’s website.
A sample system is entered below to demonstrate what one could look like.
Table 2-6 Information for RFI on Encoders
Information for RFI on Encoders Information
Vendor 1
Name of company
HIM Technologies
Name of product
Encoder Supreme
Logic or automated
Logic
Phone number of vendor
(555) 555-1234
Address
123 Main Street
Vendor 2
Vendor 3
Vendor 4
Plymouth, NJ 12345
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Section 2 Clinical Classification Systems and Reimbursement Methods 75
Summary of additional
Grouper and coding
coding/compliance
resources (e.g.,
resources beyond encoder
CodingClinic) are included but the compliance products must be purchased
Number of years on
11 years
market © 2014 Cengage Learning ®. All Rights Reserved.
Reference American Health Information Management Association (AHIMA) (n.d. 1) American Health Information Management Association (AHIMA) (n. d. 3)
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Section 2 Clinical Classification Systems and Reimbursement Methods 76
CASE 2-12 Physician Query Policy
Questions and Suggested Answers Evaluate the policy and procedure for physician queries.
The policy needs to be revised. The queries cannot be mailed because the physician needs the chart to review before answering the query. Either the chart can be pulled for the physician to review in the HIM Department or if an imaging system or electronic health record (EHR) is in place, the query can be sent via workflow technology because the chart would be available online. The policy does not give the coder any direction on how to complete the query, such as they cannot use yes or no questions, cannot lead the physician, and cannot include financial information. The form needs to be revised since it does not meet the requirements for the physician query process. An example of not meeting requirements is the reference to mailing a query back to the HIM Department.
For a revised Physician Query Form, see Figure 2-12A.
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Section 2 Clinical Classification Systems and Reimbursement Methods 77
Honolulu General Hospital Physician Query Form
Patient Name: ________________________________ DOS: ______________________ MRN: ________________________
Dr: _________________________ After review of the above-mentioned patient’s chart with discharge date of __________, for the purpose of coding, the following issue(s) were identified:
please contact:
Coder: ________________________ Phone: (___)___-_____________ To be completed by physician: Based on review of the medical record, my response to the above query is:
This information has been added to the medical record as appropriate. Physician: _____________________________ Date: ______ Figure 2-12A Revised Physician Query Form © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part
© 2014 Cengage Learning ®. All Rights Reserved.
Please review the medical record and answer the above question(s). If you have any questions,
Section 2 Clinical Classification Systems and Reimbursement Methods 78
References LaTour et al. Prophet Sayles Schraffenberger
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Section 2 Clinical Classification Systems and Reimbursement Methods 79
CASE 2-13 Physician Query Evaluation
Questions and Suggested Answers 1. Is the query well written?
Physician Queries:
1. No. It leads the physician.
2. Yes. It provides information to support your question and does not lead the physician.
3. Yes. It asks for clarification on conflicting documentation.
4. No. The question leads the physician.
5. No. It is not appropriate to ask the physician to change the documentation to increase reimbursement.
6. No. The question leads the physician.
7. No. This is a Yes/No question that leads the physician.
8. No. It begins appropriately, but then the question leads the physician.
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Section 2 Clinical Classification Systems and Reimbursement Methods 80
2. What recommendations do you have for improvement? •
Coders need to learn how to appropriately ask questions of the physician that do not lead them or mention reimbursement. All of the queries increase reimbursement. A good compliance program will have the coders asking questions of the physician that may decrease reimbursement as well as increase it. The queries should never mention any change in reimbursement—positive or negative.
•
There are problems with the form design as well. There is no room for the physician to document a response to the query and to sign and date it. The forms also do not provide physicians with how to contact the coders.
3. Do you see any trends? Yes. All of the queries increase reimbursement and are poorly written. 4. Which coders are better at writing queries?
Toni and Clarice.
References LaTour et al. Prophet Sayles Schraffenberger
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Section 2 Clinical Classification Systems and Reimbursement Methods 81
CASE 2-14 Physician Education
Questions and Suggested Answers 1. What would you recommend?
Students could include a number of different choices, but the most likely choice would be to have the HIM director report the problem to the chief of service or chief of staff. The chief of staff could meet with the 2 physicians and find out why the diagnosis of urosepsis is a problem for the coders. The physicians need to understand that they need to specify sepsis and/or urinary tract infection. There is a big difference in the diagnosis, the code, and the reimbursement. An incorrect diagnosis also creates data quality problems for research.
Other options include the following: •
The coder, coding supervisor, or HIM director could first meet with the physicians oneon-one before bringing other physicians into the problem.
•
The coders could also provide the problem physicians with a copy of the coding guidelines.
2. Why did you choose this method?
The main reason for reporting the physicians to the chief of staff is that other physicians will have much more influence with the problem documenters than the HIM staff. If the alternative options are selected by the student, he or she could support this decision by © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part
Section 2 Clinical Classification Systems and Reimbursement Methods 82
noting that the steps to take in getting the physicians to document properly should be progressive.
References LaTour et al. Price and Farley Schraffenberger
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Section 2 Clinical Classification Systems and Reimbursement Methods 83
CASE 2-15 Using Workflow Technology in Physician Query Management
Questions and Suggested Answers How can this help?
Queries can be electronically submitted to the physicians since the physicians now have access to the medical records. The physicians can use the system to respond to the queries from home, their office, or elsewhere. The ability to access the EHR for review and to be able to add documentation along with the query would facilitate the process. This flexibility and accessibility would significantly speed up the process. With the reduced turnaround time for getting responses to queries, the CFO should be able to notice the difference in unbilled cases.
References LaTour et al. Sayles
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Section 2 Clinical Classification Systems and Reimbursement Methods 84
CASE 2-16 Physician Orders for Outpatient Testing
Questions and Suggested Answers 1. How should the admissions clerk handle this situation?
The admissions clerk should explain that the facility cannot give the patient a chest x-ray without the order from the physician. The clerk has 2 options. One is to call the physician and ask him or her to fax the order, or the clerk can ask the patient to go back to the physician’s office and get the order. Either way, the clerk should be prepared to deal with an upset patient.
2. Why is having the order so important?
The facility cannot bill insurance for something that is not medically necessary. One of the ways to show medical necessity is documentation that the test was ordered by a physician.
References LaTour et al. Schraffenberger
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Section 2 Clinical Classification Systems and Reimbursement Methods 85
CASE 2-17 Report Generation
Questions and Suggested Answers 1. How should the research coordinator respond? Sample response: “I’m sorry, Dr. Smith, you asked for your patients with a diagnosis code of 486. That is not the only pneumonia code in ICD-9-CM. In fact, there is an entire range of codes for all of the different types of pneumonia. I can certainly rerun the report with all of the pneumonia codes so that we can identify all of your pneumonia cases. Would you like me to identify patients with pneumonia as principal diagnosis or principal and secondary diagnoses?”
2. What could the research coordinator have done to get the physician the information that he wanted the first time to prevent upsetting him?
The research coordinator could have anticipated that the physician would want pneumonia cases and that it was possible that the 486 codes were the only ones that he was familiar with. The research coordinator could have asked the physician if he wanted all pneumonias or just the unspecified pneumonias. Or, he or she could have asked if he wanted principal and/or secondary diagnoses of pneumonia.
Reference Schraffenberger
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Section 2 Clinical Classification Systems and Reimbursement Methods 86
CASE 2-18 Monitoring Compliance Activities
Questions and Suggested Answers 1. What are the 10 indicators that you recommend? The compliance programs, policies, and procedures should cover areas such as the following: •
Compliance risk areas
•
Hiring practices
•
Healthcare insurance and billing compliance
•
Medical records releases and informed consents
•
Professional courtesy discounts for different compliance programs and services
•
Medical necessity and documentation
•
Confidentiality and patient rights
•
Employee safety, rights, and obligations
•
Environmental concerns
•
Medical record documentation and amendment practices
2. What threshold do you recommend that the organization should strive to meet? Student’s answers will vary depending upon the 10 indicator’s they identify. However, in summation of the above-listed indicators, the recommended indicators for which thresholds should be achieved are listed in the order of importance in descending order: (1) Healthcare insurance and billing compliance, (2) Medical necessity and documentation, (3) Medical records releases and informed consents, (4) Compliance risk areas, (5) Confidentiality and patient rights, (6) Employee safety, rights, and obligations, (7) Medical record documentation and amendment practices, (8) Environmental concerns, (9) Hiring practices, and (10) Professional courtesy discounts for different compliance programs and services. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part
Section 2 Clinical Classification Systems and Reimbursement Methods 87
3. Justify your recommendations. Those indicators which have the most significant financial repercussions and are damaging to the reputation of the facility are weighted of higher importance.
Reference Office of Inspector General (OIG)(n.d.).
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Section 2 Clinical Classification Systems and Reimbursement Methods 88
CASE 2-19 Potential Compliance Issue
Questions and Suggested Answers Review the information in Table 2-7 for potential compliance issues. Write Y if the situation indicates a potential compliance problem; write N if the situation describes a simple error or insignificant finding. Justify your response.
Table 2-7 Potential Compliance Problems
Potential Compliance Problems Situation
Y/N? Why?
Principal Diagnosis (Dx): contusion,
Y.
chest
It could be an isolated coding error or a
Secondary Dx: fracture, femur
compliance error. The procedures are related to
Procedure: open reduction, internal
the fracture, which is the secondary diagnosis.
fixation (ORIF), femur
No treatment is recorded for the contusion so it should not be principal when there is another diagnosis on admission that does require a procedure. Further investigation is needed.
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Section 2 Clinical Classification Systems and Reimbursement Methods 89
Principal Dx: septicemia
N.
Secondary Dx: urinary tract infection
No problem can be identified from the information
Procedure: none
that we have.
National percent of simple pneumonia:
N.
76%
Officially you would have to run the appropriate
Your hospital’s is 77%
statistical test, but it is unlikely that one percentage point would be statistically significant.
Your case mix index (CMI) is 1.5678.
Y.
Average CMI for a comparable facility
Officially you would have to run the appropriate
is 1.2094.
statistical test, but it is likely that the difference is statistically significant. If so, the facility would need to investigate to learn why their CMI is so high compared to similar facilities.
98% of all physician queries ask
Y.
questions
Queries should be asked about documentation
that
reimbursement.
would
increase
that would increase and decrease reimbursement. While the 98% shows that there are occasional questions that decrease or have no effect on reimbursement, these questions are extremely rare. Further investigation is required.
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Section 2 Clinical Classification Systems and Reimbursement Methods 90
The number of advance beneficiary
Y.
notices (ABNs) for the past year is 1.
The facility issued only 1 ABN in a year. This is an extremely low number. Further investigation is required.
Medicare reviewed 100 heart cath
N.
charts. The MS-DRG was changed on 2
This is a very small number of MS-DRG
of the cases.
changes, which therefore does not show a pattern
A review of the remittance advice
Y.
shows 50 denials over the past month,
You would need to know the number of claims for
with 42 of those denials for medical
the past month to determine the percentage of
necessity.
claims that were denied due to medical necessity. This would probably be a compliance issue because facilities are prohibited from billing for medically unnecessary services.
An audit performed on rebills showed
N.
that 62% were for higher weighted MS-
This shows that you are serious about data
DRGs, and 38% were for lower.
quality and are correcting problems that decrease your reimbursement as well as those that increase it.
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Section 2 Clinical Classification Systems and Reimbursement Methods 91
The annual report of compliance activities
Y.
shows the following:
All services and patient types should be audited.
• Number of discharges: 22,000
The number of charts reviewed (50) was also very
• 50% of the medical services were
small compared with the number of discharges (22,000).
audited • Only inpatient services were audited • 50 charts were audited A new compliance software package was
Y.
installed in January.
Although
In March, HR evaluated salary ranges for
wonderful resource for the staff, you should never
all of the jobs in the hospital.
rely totally on the computer because there may be
The
admission
coordinator
position’s
salary was dropped by 25%.
compliance
software
can
be
a
problems with the software. You still need someone who understands compliance issues.
The new hires have a high school education and strong typing skills. The coding supervisor reviews a random
N.
sample of inpatient, outpatient, and ER
The reviews are appropriate.
records for correct coding. The sample is taken from all services, all physicians, and all coders. © 2014 Cengage Learning ®. All Rights Reserved. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part
Section 2 Clinical Classification Systems and Reimbursement Methods 92
References LaTour et al. National Center for Health Statistics (NCHS) (n.d.2) Schraffenberger
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Section 2 Clinical Classification Systems and Reimbursement Methods 93
CASE 2-20 Discharge Planning
Questions and Suggested Answers 1. What do you recommend?
The student could recommend either issuing an advanced beneficiary notice or having the patient discharged/transferred to long-term care hospital, home, or nursing home.
2. What actions do you hope have been taking place over the past month with regards to the patient’s expected discharge?
There should have been discharge planning occurring on an ongoing basis. This planning should have been getting appropriate resources lined up for discharge. The discharge planning should have lined up home health, durable medical equipment, or planning and scheduling the patient transfer to an appropriate facility.
References Abdelhak et al. LaTour et al. Sayles Schraffenberger
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Section 2 Clinical Classification Systems and Reimbursement Methods 94
CASE 2-21 Documentation Improvement
Questions and Suggested Answers 1. What should Laura recommend to the HIM director to improve documentation?
The student could come up with many options. Some examples include the following: •
Education of physicians
•
Pocket-size cheat sheets
•
Cheat sheets posted on units
•
Monitoring compliance to the standards by checking H&P content
•
Concurrent documentation audits
2. Who should be involved in this documentation improvement program?
The students could add more, but it should at least include representatives from HIM, physicians, and quality improvement. They may also want to have the compliance officer on the team.
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Section 2 Clinical Classification Systems and Reimbursement Methods 95
3. What else would you want to know?
The students would need to know the specific area where the problems were occurring so that they can design the program around these areas. The areas identified could be service, physician, diagnosis, procedure, or other category.
4. What type of follow-up should be performed? When?
After the intervention has been completed, there should be follow-up audits to see if there has been change in the physician’s documentation practices. Additional interventions would be needed until the problem(s) is resolved. Even after the problem has been solved, there should be periodic audits to ensure that the quality of the documentation remains true.
References LaTour et al. Schraffenberger
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Section 2 Clinical Classification Systems and Reimbursement Methods 96
CASE 2-22 Strategic Management of ICD-10 Implementation
Questions and Suggested Answers
What recommendation and input would you give to the committee for a systematic method to forecast the financial implications ICD-10 will have on your hospital?
The actual budgeting for the transition should appropriate costs among different departmental budgets. Also spread out costs over timeline, rather than allocating all funds in 1 or 2 years. Allow for absorption of costs over longer fiscal budget period.
Determining the expense for planning and implementing ICD-10 will involve the following:
•
Identifying all departments having information systems utilizing ICD coded data, and determining the budgetary requirements via system vendor to upgrade system software from ICD-9 to ICD-10 and any associated training.
•
Analyzing budget needs for increase of staff, permanent or temporary, to succumb loss of coding productivity/accuracy until staff are fully trained on new ICD-10 coding system
•
Identifying budget needs for temporary consultants to manage backlogs and coding accuracy.
•
Noting the likely delay in payments from third-party payers until coders and billing staff are fully trained on systems.
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Section 2 Clinical Classification Systems and Reimbursement Methods 97
•
Note the likely increase in the number of claim denials or rejections due to inadequate coding, reporting, and processing.
Reference American Health Information Management Association (AHIMA). (n. d. 2)
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Section 2 Clinical Classification Systems and Reimbursement Methods 98
CASE 2-23 Developing a Coding Quality Plan
Questions and Suggested Answers 1. What should you do to resolve the problems with quality of coding?
The student should come up with a long list of things that needs to be done. Some items that should be included are as follows: •
Training of the staff that is focused on the problems identified
•
Performing internal and external audits
•
Terminating staff whose work quality does not improve after education
•
Writing strong policies on coding practices
•
Developing quality and productivity standards
•
Evaluating coders in meeting productivity and quality standards
•
Meeting with coders one-on-one to discuss their specific problems
2. What should you do to reduce the denial rate?
You should determine the root cause of the denials and then come up with a strategy to solve the problem. There may be a trend identified that accounts for a significant number of the denials such as cardiac catheterization, septicemia, etc. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part
Section 2 Clinical Classification Systems and Reimbursement Methods 99
3. What standard for quality of coding will you recommend?
Students may come up with a variety of standards but 95–98% is recommended.
4. What standard for productivity will you recommend?
Students should come up with standards for inpatient, outpatient, and other types of records. The range can vary widely. Table 2-23A shows an example of standards.
Table 2-23A Coding Productivity Standards
Coding Productivity Standards Records per Day
Records per Hour
Time per Record
28 records
4 records
15 minutes
42 records
6 records
10 minutes
Emergency Room
120 records
15 records
4 minutes
Ancillary Services
280 records
40 records
1.5 minutes
Inpatient
Outpatient surgery
Source: Devault 2012. © 2014 Cengage Learning ®. All Rights Reserved.
References Abdelhak et al. Castro and Layman Devault
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Section 2 Clinical Classification Systems and Reimbursement Methods 100
LaTour et al. Price and Farley Schraffenberger
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Section 2 Clinical Classification Systems and Reimbursement Methods 101
CASE 2-24 High-Risk Medicare-Severity Diagnosis-Related Groups (MS-DRGs)
Questions and Suggested Answers 2. Create a plan for monitoring these MS-DRGs.
Include at least the types of monitoring, sample size, frequency, case selection, documentation, reporting, and corrective action plans.
Monitoring high-risk areas should be addressed in the compliance plan. Some of the options include the following: •
Complications/comorbidity (CC) or no CC monitoring
•
Prebill review
•
External and internal audits
•
Strong policies
The timing of the audits could be daily, weekly, monthly, or even quarterly based on the needs of organization and the time that the coding supervisor has allocated to coding quality. The actual sample size can be a specific number of charts per week or other period. They could also be selected by coder or by valid sampling techniques. The audits could also be based on a percentage of the high-risk MS-DRGs. Any trends identified in the audit should be reported to the compliance officer. The coding supervisor should review policies and update as needed. When a problem is identified or suspected, the area would need more © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part
Section 2 Clinical Classification Systems and Reimbursement Methods 102
rigorous review to determine the severity of the problem. The coder or coders involved would need to be educated so that the problems do not continue to occur. The review would need to continue until you are sure that the problem is resolved. Then a periodic audit is necessary to ensure that the problem does not return. All activities must be documented.
The documentation should include: •
Action taken
•
Any changes in policies
•
Audit findings such as the number of charts reviewed and number/types of errors
•
Report of audit findings
References LaTour et al. Price and Farley Schraffenberger
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Section 2 Clinical Classification Systems and Reimbursement Methods 103
CASE 2-25 Medicare-Severity Diagnosis-Related Group (MS-DRG) Comparisons
Questions and Suggested Answers 1. Identify the MS-DRG geometric mean length of stay for the MS-DRGs in Table 2-8 from Table 2-11. Compare the national geometric mean length of stay to your average length of stay. Determine if the difference between them is statistically significant. Table 2-8
Geometric Mean Length of Stay Average Length of Stay
Medicare-Severity
Hospital
Geometric
Hospital
National
Statistically
Diagnosis-Related Group
ALOS
Mean LOS
Discharges
Discharges Significant
061
3.6
6.4
2
3,938
No
062
5.6
4.8
3
5,496
No
063
3.1
3.4
2
2,091
No
088
4.6
4.2
4
1,307
No
089
3.1
2.9
4
3,487
No
090
2.3
1.9
2
3,010
No
190
4.4
4.5
121
189,511
No
191
3.8
3.8
85
162,090
No
192
3.9
3.1
62
155,808
No
215
7.1
6.9
2
174
No
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Section 2 Clinical Classification Systems and Reimbursement Methods 104
2. Determine the national average charges information for the MS-DRGs in Table 2-9 by using Table 2-11. Compare the 2 figures. Determine if the difference between them is statistically significant. Table 2-9
Average Charges Average Charges
MS-Diagnosis-
Hospital
National
Hospital
National
Statistically
Related Group
Charges
Charges
Discharges Discharges
Significant
061
$74,842
$77,078.29
2
3,938
No
062
$51,235
$53,253.63
3
5,496
No
063
$46,789
$44,778.45
2
2,091
No
088
$45,952
$39,879.88
4
1,307
No
089
$6,205
$26,390.03
4
3,487
No
090
$24,452
$21,343.79
2
3,010
No
190
$28,568
$28,134.36
121
189,511
No
191
$22,301
$83,233.30
85
162,090
No
192
$17,633
$62,036.58
62
155,808
No
215
$3420.00
$41,981.07
2
174
No
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Section 2 Clinical Classification Systems and Reimbursement Methods 105
3. Determine the average reimbursement data for the MS-DRGS in Table 2-10. The national data can be found in Table 2-11. Compare the 2 figures. Determine if the difference between them is statistically significant. Table 2-10
Average Reimbursements Average Reimbursements
MS-DiagnosisHospital
Hospital
National
Statistically
Discharges
Discharges Significant
National
Related Group 061
$3,960
15,943.61
2
3,938
062
$9,900
9,626.09
3
5,496
063
$8,425
7,182.15
2
2,091
088
$6,521
7,658.17
4
1,307
089
$4,753
4,343.47
4
3,487
090
$3,573
3,001.16
2
3,010
190
$5,821
5,866.62
121
189,511
191
$4,503
4,500.11
85
162,090
192
$3,523
3,064.76
62
155,808
215
$53,245
93,619.96
2
174
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4. Complete Tables 2-8 through 2-10 and write a memo to the CFO describing your findings. Use the information in Tables 2-8 through 2-10 to determine if there is a significant difference between the 2 figures that may indicate over/undercoding.
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Section 2 Clinical Classification Systems and Reimbursement Methods 106
A t-test was run on the data to determine if the difference between the hospital and the national data is statistically significant at the .05 level. The findings are reported in the statistical significance column of each table.
References Castro and Layman Centers for Medicare and Medicaid Services (CMS). (n.d.1) LaTour et al. Price and Farley Schraffenberger
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Section 2 Clinical Classification Systems and Reimbursement Methods 107
CASE 2-26 Medicare-Severity Diagnosis-Related Group (MS-DRG) Changes
Questions and Suggested Answers Write the letter to support your choice of principal diagnosis.
Figure 2-26A is a sample of what a letter could look like. The letter should be on hospital
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letterhead.
Figure 2-26A Letter of Appeal
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Section 2 Clinical Classification Systems and Reimbursement Methods 108
References Castro and Layman Holland
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Section 2 Clinical Classification Systems and Reimbursement Methods 109
CASE 2-27 Complication/Comorbidity (CC) Medicare-Severity Diagnosis-Related Group (MS-DRG) Analysis
Questions and Suggested Answers Use the information in Table 2-12 to calculate a MCC percentage for your facility and then determine if there is a statistically significant difference between the 2 figures at the 0.05 level.
1. What are the CC/no CC DRG pairs?
They are DRG pairs impacted by the presence or absence of complications or comorbidities.
2. What can you learn by reviewing them?
If your variance of CC/no CC percentages is statistically significantly different from the national average, this may indicate a problem with overcoding. Further study is required to determine if there is a legitimate reason for the difference or if the variance is truly caused by overcoding. The trends should be monitored monthly as part of your routine compliance monitoring. A corrective action plan should be developed when a problem is identified.
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Section 2 Clinical Classification Systems and Reimbursement Methods 110
Table 2-12 Complication/Comorbidity Diagnosis-Related Group (DRG) Analysis
Complication/Comorbidity DRG Analysis MS-DRG Number
National
of Cases Number
National % Hospital % Variance % Possible with cc
with cc
with cc
Over/Undercoding?
of Cases 10
157
19,440
87.0
82.2 –5.51
Overcoding or undercoding unlikely
11
24
3,456
16
123
10,929
78.4
85.5 +9.1
Overcoding or undercoding likely
17
155
2,852
24
21
61,536
69.3
70.2 +1.3
Overcoding or undercoding unlikely
25
18
28,724
31
2
4,748
71.5
65.5 –9.2
Overcoding or undercoding likely
32
5
2,013
79
55
174,044
65.4
72.0 +8.6
Overcoding or undercoding likely
80
43
7,981
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Section 2 Clinical Classification Systems and Reimbursement Methods 111
99
123
22,081
84.1
83.0 –1.1
Overcoding or undercoding unlikely
100
175
7,677
182
54
294,294
71.2
74.0 +3.9
Overcoding or undercoding unlikely
183
78
91,571
253
175
23,830
37.2
38.0 +2.2
Overcoding or undercoding unlikely
254
154
10,955
304
63
13,493
83.5
81.0 –3.0
Overcoding or undercoding unlikely
305
54
3,139
493
32
61,558
62.4
64.0 +2.6
Overcoding or undercoding unlikely
494
45
27,412
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Section 2 Clinical Classification Systems and Reimbursement Methods 112
References Castro and Layman Price and Farley Schraffenberger
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Section 2 Clinical Classification Systems and Reimbursement Methods 113
CASE 2-28 Estimated Medicare-Security Diagnosis-Related Group (MS-DRG) Payments
Questions and Suggested Answers Use Table 2-13 to enter the relative weight from Table 2-14 and calculate the estimated payment.
Table 2-13 Medicare-Severity Diagnosis-Related Groups (MS-DRGs) with Relative Weight and Estimated Payment
MS-DRG with Relative Weight and Estimated Payment
MS-DRG
Relative
Estimated
Weight
Payment
1.1924
$7,764.10
MS-DRG Title
Chronic Obstructive Pulmonary Disease 190 without MCC 193
Simple Pneumonia & Pleurisy with MCC
1.4796
$9,634.15
231
Coronary Bypass with PTCA with MCC
7.8582
$51,167.26
1.1912
$7,756.28
Acute Myocardial Infarction Discharged 281 Alive with CC 304
Hypertension with MCC
1.0263
$6,682.57
334
Rectal Resection without MCC/CC
1.6267
$10,591.96
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Section 2 Clinical Classification Systems and Reimbursement Methods 114
374
Digestive Malignancy with MCC
2.0674
$13,461.50
389
GI Obstruction with CC
0.9344
$6,084.18
472
Cervical Spinal Fusion with CC
2.7722
$18,050.68
509
Arthroscopy
2.7722
$18,050.68
© 2014 Cengage Learning ®. All Rights Reserved.
References Castro and Layman Centers for Medicare and Medicaid Services (CMS) (n.d. 2) Schraffenberger
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Section 2 Clinical Classification Systems and Reimbursement Methods 115
CASE 2-29 Case Mix Index (CMI) Trends
Questions and Suggested Answers 1. Create a line graph showing the national and facility CMI for years 2011 and 2012 using the information in Table 2-15.
Table 2-15Quarterly Case Mix Index (CMI) Quarterly CMI Quarter
CMI
First quarter 2011
1.2354
Second quarter 2011
1.2456
Third quarter 2011
1.2156
Fourth quarter 2011
1.4354
First quarter 2012
1.3541
Second quarter 2012
1.3251
Third quarter 2012
1.3296
Fourth quarter 2012
1.3357
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See Figure 2-29A for a comparison between national CMI and facility CMI.
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Section 2 Clinical Classification Systems and Reimbursement Methods 116
2. What trend(s) do you see from the comparison? The facility’s CMI is consistently well below the national CMI with one exception. There was major increase in the CMI in the fourth quarter of 2011, which placed it slightly above the national average. The next quarter it dropped down but not to the previous levels. The CMI for the second, third, and fourth quarters of 2012 are stable.
3. What information would you want to know if you were analyzing the reasons behind the trends?
The student can list a number of different things. Examples include: investigate patient population to determine your top MS-DRGs, why there was a major increase in the fourth quarter of 2011, and why the CMI has stabilized at a rate higher than in 2012.
4. Give 3 possible reasons that would explain any trend(s).
The student has a lot of flexibility here. Some possibilities that may be listed include the following: •
New services are being performed.
•
A natural disaster has happened.
•
There are changes in the relative weights by CMS.
•
There have been improvements in coding quality.
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Section 2 Clinical Classification Systems and Reimbursement Methods 117
References
Abdelhak et al. Castro and Layman LaTour et al. Sayles
© 2014 Cengage Learning ®. All Rights Reserved.
Schraffenberger
Figure 2-29A Comparison between National CMI and Facility CMI
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Section 2 Clinical Classification Systems and Reimbursement Methods 118
CASE 2-30 Case Mix Index (CMI) Investigation
Questions and Suggested Answers 1. Use the information in Table 2-16 to make a line graph of the CMI for calendar years 2010, 2011, and 2012.
Total the CMI for each month and divide by 12 to get the annual CMI. A graph of the CMI for the 3 calendar years is provided in Figure 2-30A.
Table 2-16 Case Mix Index (CMI) for Years 2010, 2011, and 2012 by Month
CMI by Month Years 2010, 2011, and 2012 Year/Month
2010
2011
2012
January
1.4321
1.3276
1.3756
February
1.3215
1.2535
1.4544
March
1.2487
1.2478
1.2489
April
1.5789
2.2435
1.2570
May
1.5789
1.5248
1.5278
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Section 2 Clinical Classification Systems and Reimbursement Methods 119
June
1.5321
1.4245
1.5741
July
1.2635
1.2857
1.2576
August
1.5227
1.4456
1.5700
September
1.4568
1.2357
1.2768
October
1.2748
1.2575
1.2578
November
1.3578
1.3574
1.4456
December
1.2357
1.6574
1.5788
Annual
1.4003
1.4384
1.4020
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Figure 2-30A Case Mix Index
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Section 2 Clinical Classification Systems and Reimbursement Methods 120
2. What trends can you identify? The relative weights for 2010 and 2012 were extremely close, but there was an increase in the CMI for 2011. This increase was very small, 00381, compared to the CMIs in 2010 and 2012.
3. Can you identify any cause for concern?
This monitoring should be done each quarter instead of rushing and doing it for a meeting several years later. The CMI is stable. There was a very small increase, so it is most likely not statistically significant.
4. What investigation would you want to conduct?
MS-DRGs have been around for more than 20 years now. The facility should update the graph with the CMI from additional years. This would let the facility know what the CMI was for previous years to determine if the stability of the CMI is new or has been consistent over the years.
References Abdelhak et al. Castro and Layman LaTour et al. Sayles Schraffenberger (2005)
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Section 2 Clinical Classification Systems and Reimbursement Methods 121
CASE 2-31 Top 10 Medicare-Severity Diagnosis-Related Groups (MS-DRGs)
Questions and Suggested Answers What were the top 10 MS-DRGs by revenue and by discharges?
MS-DRG information can be found on the student companion website.
Information supporting the figures contained in Table 2-17A is contained in Table 2-17. The revenue was calculated by multiplying the relative weight by the number of discharges.
That figure was multiplied by $5,792.38 and the add-on amount of $268.00 was added to this figure. The case did have extraneous information that the student did not need to complete the case study.
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Section 2 Clinical Classification Systems and Reimbursement Methods 122
Table 2-17A Top 10 MS-Diagnosis-Related Groups (MS-DRGs) by Revenue and by Discharges
Top 10 MS-DRGS by Revenue
Top 10 MS-DRGs by Discharges
MS-DRG 466
MS-DRG 484
MS-DRG 484
MS-DRG 466
MS-DRG 465
MS-DRG 465
MS-DRG 228
MS-DRG 502
MS-DRG 464
MS-DRG 767
MS-DRG 768
MS-DRG 768
MS-DRG 478
MS-DRG 795
MS-DRG 220
MS-DRG 464
MS-DRG 229
MS-DRG 478
MS-DRG 502
MS-DRG 775
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Section 2 Clinical Classification Systems and Reimbursement Methods 123
References Abdelhak et al. Castro and Layman Centers for Medicare and Medicaid Services (CMS). (n.d.1) LaTour et al. Sayles Schraffenberger
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Section 2 Clinical Classification Systems and Reimbursement Methods 124
CASE 2-32 Case Mix Index (CMI) Analysis
Questions and Suggested Answers 1. Use the data provided in Table 2-17 to calculate the CMI.
Multiply the relative weight by the number of patients. Total the number of patients and the extended relative weight. Divide the extended relative weight by the number of patients:
Total number of patients: 28,440
Extended Relative Weight (Extended RW): 54,637.9
Case Mix Index (CMI):
1.9212
Calculation: 54,637.9/28,440 = 1.92122
2. What does the CMI tell you about the facility?
The CMI for this example is 1.92122. This is slightly over the average relative weight of 1.0000. Because the CMI is just over the average of 1.0000, one would not expect this facility to be a major health care facility or possibly even a teaching facility or a research facility that has transplants, major trauma, or other high relative weight MS-DRGs.
The CMI gives the facility their average relative weight. This can be monitored over time to show trends. This is important because the higher the relative weight, the higher the reimbursement. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part
Section 2 Clinical Classification Systems and Reimbursement Methods 125
3. What would you need to do to increase your CMI? Include HIM- and facility-related activities. Give the students 6 ideas of what could be done increase your CMI? Include HIM- and facilityrelated activities.
HIM related:
Coding and DRG assignments are important to the CMI because these are used to calculate the CMI. If there are coding issues, then correcting these may have a positive impact on the CMI. If coding quality is good, then coding is not the answer to improve the CMI. Documentation improvement may be the key. If your physicians are not clear in their documentation, or if they do not include significant information for DRG assignment, then you would need to implement a documentation improvement program.
Hospital related:
Because coders can only code what was done to the patient, the services that the hospital performs and the activities of the medical staff control the CMI. If the administration wants the CMI to increase, they need to recruit physicians whose patients fall into high-paying MS-DRGs (such as cardiologists) instead of family practice physicians who admit patients with low-paying DRGs (e.g., patients with dehydration). They may want to open new services such as transplants, trauma, and cardiac surgery to bring in patients who will be grouped into higher weighted MS-DRGs.
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Section 2 Clinical Classification Systems and Reimbursement Methods 126
References Castro and Layman LaTour et al. Schraffenberger
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Section 2 Clinical Classification Systems and Reimbursement Methods 127
CASE 2-33 Medicare Provider Analysis and Review (MEDPAR) Data Analysis
Questions and Suggested Answers Based on the data in the Tables 2-18 and 2-19, identify/answer the following: 1. What are the top 20 MS-DRGs by number of discharges? See Table 2-33A. 2. What are the top 10 MS-DRGs by patient days? See Table 2-33A. 3. What are the highest 5 MS-DRGs by ALOS? See Table 2-33A. 4. What state is the most efficient based on ALOS? Idaho, 4.3. 5. What state is the most efficient based on average charge? Puerto Rico. If you exclude Puerto Rico because it is not technically a state, the next in line is Unknown. If you disregard unknown, the first state is Maryland. 6. How can MEDPAR data be used by a hospital?
Identifying the average length of stay or average charges for all hospitals in your state gives you something to compare your charges and ALOS against. You could check any variances for statistical significance.
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Section 2 Clinical Classification Systems and Reimbursement Methods 128
Table 2-33A
Top 20 Medicare-Severity Diagnosis-Related Groups (MS-DRGs) by
Number of Discharges, Top 10 MS-DRGs by Patient Days, and the 5 Highest MS-DRGs by ALOS
Top 20 MS-DRGs by Number of
Top 10 MS-DRGs
5 Highest MS-DRGs
Discharges
by Patient Days
by ALOS
1. MS-DRG 470
11. MS-DRG 945
1. MS-DRG 885
1. MS-DRG 003
2. MS-DRG 871
12. MS-DRG 190
2. MS-DRG 871
2. MS-DRG 927
3. MS-DRG 885
13. MS-DRG 193
3. MS-DRG 945
3. MS-DRG 004
4. MS-DRG 291
14. MS-DRG 641
4. MS-DRG 470
4. MS-DRG 837
5. MS-DRG 392
15. MS-DRG 247
5. MS-DRG 291
5. MS-DRG 9
6. MS-DRG 690
16. MS-DRG 191
6. MS-DRG 193
7. MS-DRG 292
17. MS-DRG 603
7. MS-DRG 190
8. MS-DRG 313
18. MS-DRG 192
8. MS-DRG 194
9. MS-DRG 194
19. MS-DRG 310
9. MS-DRG 392
10. MS-DRG 312
20. MS-DRG 284
10. MS-DRG 292
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Section 2 Clinical Classification Systems and Reimbursement Methods 129
References Centers for Medicare and Medicaid Services (CMS). (n.d.1) Sayles
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Section 2 Clinical Classification Systems and Reimbursement Methods 130
CASE 2-34 Explanation of Benefits (EOB)
Questions and Suggested Answers 1. What would you say to explain what an Explanation of Benefits form is?
An Explanation of Benefits (EOB) form is a summary of what the physician billed and the insurance company’s analysis of the claim. It tells what the insurance company has agreed to pay and what you as the patient are required to pay.
2. How would you explain the difference between the amount submitted and the amount allowed?
The insurance company pays the usual, customary, and reasonable (UCR) charge or the actual charge—whichever is lower. This amount is the amount that the insurance company “allows” the provider to charge. The amount submitted is the amount charged for the services by the physician’s office. The amount charged and the allowed charge is usually different because of the UCR. The coinsurance is calculated based on the allowed charge, not the actual charge.
3. After you explain the difference between the amount submitted and the amount allowed to her, the patient gets irate and exclaims, “How dare Dr. Simmons overcharge me by $8.00!” She then says that she is going to call his office and give him a piece of her mind. What will you say in response?
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Section 2 Clinical Classification Systems and Reimbursement Methods 131
Explain that Dr. Simmons did not overcharge. The insurance company sets what they are willing to pay—the allowable charge. The allowed charge is based on the average charge for the area. Because this is an average, some physicians charge more, others less. So this is not an overcharge.
References Castro and Layman LaTour et al. Sayles
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Section 2 Clinical Classification Systems and Reimbursement Methods 132
CASE 2-35 Qualification for Insurance
Questions and Suggested Answers Review the patients described in Table 2-21 and explain which insurance plan they are most likely to be enrolled in.
Table 2-21 Patient Situations and Probable Insurer
Patient Situation and Probable Insurer Patient Situation
Probable Insurer
A 72-year-old male with diabetes
Medicare—patient is 65 or older
A 45-year-old female with end-stage renal disease
Medicare—patient has ESRD
(ESRD) A newborn born to mother on Medicaid
Medicaid because mother is on Medicaid
A 24-year-old female who works at Metro
Commercial because patient is employed
Hospital who was admitted for delivery A 33-year-old single mother who makes $8,000.00
Medicaid because her income is so low
per year
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Section 2 Clinical Classification Systems and Reimbursement Methods 133
A 26-year-old construction worker who fell off a
Worker’s compensation because this
ladder and broke his arm at work
happened at work
A 54-year-old male with urticaria; his wife is in
TRICARE because he is a military
the military
dependent, but he could have his own insurance with his employer
A 64-year-old female with clinical depression; her
Commercial because the patient’s
husband is a coal miner
husband works and probably has insurance through his employer
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References Abdelhak et al. Castro and Layman LaTour et al. Sayles
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Section 2 Clinical Classification Systems and Reimbursement Methods 134
CASE 2-36 Medicare Part D
Questions and Suggested Answers Would you recommend she enroll in Medicare Part D? Justify.
Medicare D has a number of plans that the patient can select from. Information about Medicare Part D plans can be accessed on the CMS website.
The patient would need to analyze the premium costs, deductible, and copay to determine if this is a savings from her current spending level of $250.00. The patient can compare 2 or 3 plans and select the appropriate one. The patient currently spends $3,000.00 per year. Calculate the patient’s annual expense by adding the total premium for the year, the deductible, and the patient’s total copay for the year.
Total premium for the year = The monthly premium × 12 (months)
Total copay = Copay × number of drugs (4) × 12 (months)
In this example, it would be cost-effective for the patient to join Medicare Part D. She would save money in all of the plans studied.
Table 2-36A shows an example of the analysis.
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Section 2 Clinical Classification Systems and Reimbursement Methods 135
Table 2-36A Sample Analysis of Part D Plans
Plan
Monthly
Deductible Copay Patient Annual Expenses
Premium Plan A
$17.00
$265.00
$25.00
($17.00 × 12) + $265.00 + (($25 × 4) × 12) = $1,669.00
Plan B
$26.00
$0.00
$45.00
($26.00 × 12) + $0.00 + (($45 × 4) × 12) = $2,472.00
Plan C
$35.00
$250.00
$20.00
($35.00 × 12) + $250.00 + (($20 × 4) × 12) = $1,630.00
No Plan
$3,000.00 (patient’s current annual expense for drugs)
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Reference Department of Health and Human Services (n.d.)
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Section 2 Clinical Classification Systems and Reimbursement Methods 136
CASE 2-37 Medicare Coverage
Questions and Suggested Answers Identify whether Medicare A, Medicare B, Medicare C, or Medicare D covers each of the services in Table 2-22.
Table 2-22 Medicare Services
Service
Medicare Part
Prescriptions
D
Physician office visit
B
Hospice
A
Lab tests
B
Physical therapy
B
Long-term care
A
hospitalization Inpatient hospitalization
A
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Section 2 Clinical Classification Systems and Reimbursement Methods 137
Dental services
C
Same-day surgery
B
Durable medical equipment
B
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References Castro and Layman Centers for Medicare and Medicaid Services (n.d. 1) LaTour et al. Sayles
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Section 2 Clinical Classification Systems and Reimbursement Methods 138
CASE 2-38 Local Care Determination (LCD)
Questions and Suggested Answers Look up your state LCD for each procedure identified in Table 2-23 and fill in the table. The LCDs are subject to change so the information on the website may vary slightly from the information provided here. In this example, the state of Georgia was selected.
Table 2-23 Local Care Determination (LCD)
Local Care Determination (LCD) Procedure
Medicare
Limitations? (Summarize)
Coverage? Blepharoplasty
Yes
Yes, it must be reconstructive or
Date Last
LCD
Reviewed
Number
10/22/12
L2997
10/13/11
L30004
meet certain criteria such as chronic blepharitis or eyelid drooping so badly that it inhibits reading. Debridement of
Yes
mycotic nails B-scan
LCD specifies what is considered to be debridement and what is not covered.
No LCD for Georgia
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Section 2 Clinical Classification Systems and Reimbursement Methods 139
Sleep disorders
No Georgia
testing
LCD
Blood glucose
No LCD for
testing
Georgia
Skin substitutes
Yes
Ulcers
8/3/12
L30135
Walkers
Yes
Does not cover accessories
8/4/11
A35233
Nail avulsion
No Georgia LCD
Group
No Georgia
psychotherapy
LCD
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Reference Centers for Medicare and Medicaid Services (CMS). (n.d.)
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Section 2 Clinical Classification Systems and Reimbursement Methods 140
CASE 2-39 National Coverage Determination (NCD)
Questions and Suggested Answers Look up the NCD for each procedure identified in Table 2-24 and fill in the rest of the table.
The LCDs are subject to change so the information on the website may vary slightly from the information provided here. NCDs can be found on the Internet at http://www.cms.hhs.gov.
Table 2-24 National Coverage Determination (NCD) Table
National Coverage Determination Procedure
Medicare
Limitations?
Implementation
NCD
Date
Section
Not posted
280.10
7/16/98
190.3
Coverage? Prosthetic shoe
No
Cytogenetic studies Yes
Reasonable and necessary
Treatment of
Yes
None
11/26/01
250.4
Yes
Limitation when using
4/3/09
220.6.1
actinic keratosis PET for perfusion of the heart
Rubidium 82 and Ammonia N-24
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Section 2 Clinical Classification Systems and Reimbursement Methods 141
Colonic irrigation
Yes
Moderate/severe
4/4/05
240.4
6/19/06
80.11
obstructive sleep apnea (OSA), must be ordered by physician and use apnea hypopnea index (AHI) standards Vitrectomy
Yes
Lists specific conditions for which it is approved
Gastric freezing
No
Procedure is obsolete
Not posted
100.6
Ambulatory EEG
Yes
Lists specific conditions
6/12/84
160.2
monitoring
for which it is approved
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References Centers for Medicare and Medicaid Services (CMS). (n.d.1) Schraffenberger
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Section 2 Clinical Classification Systems and Reimbursement Methods 142
CASE 2-40 Calculating Medicare Inpatient Psychiatric Reimbursement
Questions and Suggested Answers Determine the reimbursements for the discharges shown in Tables 2-25–2-29.
The federal payments were calculated with the IPF PPS Payment Calculator—RY 2007. (Accessed May, 20, 2013, at IPF PPS Payment Calculator—RY 2009.)
If the student uses a different calculator, then the figures will differ from these.
Case 1: $22,963.88
Case 2: $7,966.55
Case 3: $8,082.58
Case 4: $4,266.11
Case 5: $9710.97
Reference Centers for Medicare and Medicaid Statistics (CMS). (n.d. 3)
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Section 2 Clinical Classification Systems and Reimbursement Methods 143
CASE 2-41 Medical Necessity
Questions and Suggested Answers 1. After a review of the denial, do you believe an appeal is warranted? Why or why not?
The record is not provided so students can be creative in their case or you can give the student a medical record to use. The letter should justify why the case was medically necessary. It should include specific details including test results, symptoms, etc.
2. If an appeal is warranted, write the appeal letter. If an appeal is not warranted write a letter to the Chief Compliance Officer justifying your decision.
If the student decides not to appeal the decision, the student would need to write a letter to the Chief Compliance Officer stating why they agree with the denial.
A sample appeal letter is given in Figure 2-41A.
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Section 2 Clinical Classification Systems and Reimbursement Methods 144
Figure 2-41A Medical Necessity Rebuttal Letter
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Section 2 Clinical Classification Systems and Reimbursement Methods 145
References Holland Schraffenberger
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Section 2 Clinical Classification Systems and Reimbursement Methods 146
CASE 2-42 Calculating Commercial Insurance Reimbursement
Questions and Suggested Answers Calculate the coinsurance, amount insurance will pay, and how much the patient owes.
The patient pays a flat $20.00 copay for physician office visits but pays 20% coinsurance for other services such as radiology and physical therapy. The 20% is calculated on the UCR, not the charge. In Table 2-30, each column is totaled to show the amount of money involved for each category.
Table 2-30 Calculating Commercial Insurance Reimbursement
Calculating Commercial Insurance Reimbursement Service
Charge
Usual,
Copay
Coinsurance
Insurance
Customary, and
Due from
Pays ($)
Reasonable
Patient
Physician Visit
$120.00
$120.00
$20.00
$0.00
$100.00
Physical Therapy
$150.00
$97.00
$0.00
$19.40
$77.60
X-ray
$76.00
$43.00
$0.00
$8.60
$34.40
MRI
$1,245.00
$1,047.00
$0.00
$209.40
$837.60
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Section 2 Clinical Classification Systems and Reimbursement Methods 147
Physician Visit
$65.00
$70.00
$20.00
$0.00
$50.00
Physician Visit
$75.00
$70.00
$20.00
$14.00
$50.00
$1,731.00
$1,447.00
$60.00
$251.40
$1,149.60
Totals
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References Castro and Layman LaTour et al.
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Section 2 Clinical Classification Systems and Reimbursement Methods 148
CASE 2-43 Ambulatory Payment Classification (APC)
Questions and Suggested Answers For each ambulatory payment classification (APC) in Table 2-31, identify the status indicator for the APC and indicate if discounting applies to the APC.
Go to the CMS website at www.cms.gov to research the APC status indicator. Only a status indicator of S is subject to discounting.
Table 2-31 Ambulatory Payment Classifications (APCs) with the Status Indicator and Discounting Status
APCs with the Status Indicator and Discounting Status APC
Status Indicator
Subject to Discounting
0001
S
No
0077
S
No
0170
P
No
0237
T
Yes
0429
T
Yes
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Section 2 Clinical Classification Systems and Reimbursement Methods 149
0617
S
No
0890
K
No
1011
R
No
1555
T
Yes
1830
H
No
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References American Medical Association (2011) Castro and Layman LaTour et al.
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Section 2 Clinical Classification Systems and Reimbursement Methods 150
CASE 2-44 Discharged Not Final Billed (DNFB) Reduction
Questions and Suggested Answers 1. Where would you begin to give your CEO immediate results?
The first thing to do is to analyze the report given in the case to see where you can get a big impact quickly. The analysis is shown in Table 2-44A.
Table 2-44A Discharge Not Final Billed (DNFB) Report Analysis
DFNB Analysis Reason for Being on DNFB
Quantity of Cases
Reimbursement Impact
Missing Codes
6
$38,350.55
Missing Discharge Disposition
4
$47,420.38
Missing Admitting Diagnosis
1
$23,731.80
Billers Hold
0
$0.00
Other—HIM
1
$39,652.13
Other—Business Office
1
$57,764.22
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Section 2 Clinical Classification Systems and Reimbursement Methods 151
The missing discharge disposition and admitting diagnosis cases can be quickly completed. You will need to pull the charts and abstract the information from the chart into the financial information system. This would complete 41% of the report. From there, you can gradually start working on the other cases that will take you more time to process.
2. What problems can you identify that got you into this situation?
In reviewing Table 2-32 in the case study book, it looks like the list may not be worked for high-dollar charts. There are several accounts that have very high-dollar amounts such as account numbers 1239999 and 1305790. If just these 2 cases are removed from the DNFB report, the DNFB would drop by $97,416.35, or 47%. The problem keeping these claims from being billed are unknown because they are listed as other—HIM and other—Business Office. You would need to contact the business office to handle their account. You will also need to evaluate the problem that is keeping your account from being dropped.
3. What are some possible solutions for these problems? •
The discharge dispositions and missing admission diagnoses are simple carelessness. They should have been entered when the coders were entered. You could talk to your technology staff to determine if these fields could be identified as required fields and would not let you go any further in the abstracting unless these fields are entered.
•
The charts have not been coded, maybe because of missing charts and/or missing documentation in the chart (i.e., diagnoses or discharge summary). In these cases, you may want to investigate ways to get physicians to complete these charts on a priority basis so that the bill can be dropped.
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Section 2 Clinical Classification Systems and Reimbursement Methods 152
•
Typically administration will give HIM a dollar figure that they want the DNFB list to stay below. Once the DNFB drops below the mandated amount, the DNFB list should be worked on daily to keep it down.
Reference Schraffenberger
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Section 2 Clinical Classification Systems and Reimbursement Methods 153
CASE 2-45 Chargemaster Updates
Questions and Suggested Answers 1. You have been asked to develop the process that will clean up the chargemaster as well as the process that will keep the chargemaster current on an ongoing basis. Include your recommendations for staffing in your plan.
This assignment allows for some creativity on part of the student. The student can make recommendations that include but are not limited to the following: •
Annual update of codes
•
Periodic review of charges
•
Periodic review for duplicates
•
Periodic deletion of outdated entries
•
Chargemaster committee
•
Policy and procedure
•
One person with ultimate responsibility
Reference Schraffenberger
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Section 2 Clinical Classification Systems and Reimbursement Methods 154
CASE 2-46 Monitoring Revenue Cycle
Questions and Suggested Answers 1. What are the 20 indicators you recommend? There are many possibilities that the student could come up with. Examples include the following: •
Amount of DNFB
•
Case mix index
•
CC/MCC versus no CC/MCC percentage
•
MS-DRG changes
•
Denials received
•
Amount of DNFB by reason type
•
Denials overturned
•
Claims rejected
•
Bad debt
•
Profitable MS-DRGs
•
Unprofitable MS-DRGs
•
Top MS-DRGs
•
Physician comparisons by MS-DRG
•
Coding errors
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part
Section 2 Clinical Classification Systems and Reimbursement Methods 155
2. What threshold do you recommend that the organization should strive to meet? Thresholds can vary by indicator but typically range from 90% to 98% but in some cases can be lower. 3. Justify your recommendations. The student will write reasons why they chose the indicators and thresholds that they did.
Reference Schraffenberger
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Section 2 Clinical Classification Systems and Reimbursement Methods 156
CASE 2-47 Corrective Action Plan
Questions and Suggested Answers Write a corrective action plan to decrease the number of denials received due to medical necessity. Students can come up with a number of corrective actions which include, but are not limited to: •
Educating physicians on documentation
•
Monitoring for situations where an advanced beneficiary notice would be appropriate
•
Training physicians to clearly document the type of admission
•
Training staff on importance of proper admission types
•
Use of queries
Reference Schraffenberger
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part
Section 2 Clinical Classification Systems and Reimbursement Methods 157
References Abdelhak, M., Grostick, S., Hanken, M. A., & Jacobs, E. (2012). Health information: Management of a strategic resource (4th ed.). Philadelphia: W. B. Saunders.
American Health Information Management Association (AHIMA). (n.d. 1). Vendor directory. Retrieved from www.ahimanet.org/vendordirectory/index.cfm.
American Health Information Management Association (AHIMA) (n. d. 3) The RFP Process for EHR Systems (Updated) Accessed June 17, 2013 from http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047961.hcsp?dDocName =bok1_047961
American Health Information Management Association (AHIMA). (n.d.2). ICD-10-CM/PCS Transition: Planning and Preparation Checklist. Accessed June 17, 2013 from http://www.ahima.org/downloads/pdfs/resources/checklist.pdf American Hospital Association. (n. d.). Addendum A – final OPPS APCs for CY 2012. Accessed June 17, 2013 from http://www.aha.org/content/11/c-finalrule-2012-add-A-comp-112511values.xlsx
American Hospital Association. AHA coding clinic for ICD-9-CM. Chicago: Author. 2005 3rd quarter, page 13 2004 3rd quarter, pages 9–10
American Medical Association. CPT assistant. Chicago: Author. 12/2004 page 19—42145 © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part
Section 2 Clinical Classification Systems and Reimbursement Methods 158
2/2005, pages 14–15—22851
American Medical Association (AMA). (2011). Current procedural terminology: CPT 2012, professional edition. Chicago: Author. American Medical Association(AMA). ICD-9-CM changes: An insider’s view, 2004 edition. (2003). Chicago: Author. American Medical Association(AMA). ICD-9-CM changes: An insider’s view, 2006 edition. (2005). Chicago: Author.
Castro, A. B., & Layman, E. (2011). Principles of healthcare reimbursement. Chicago: American Health Information Management Association.
Centers for Medicare and Medicaid Services (CMS). (n.d.1). Welcome to the medicare coverage database. Assessed June 17, 2013 from
http://www.cms.gov/medicare-coverage-database
http://www.cms.gov/medicare-coverage-database/overview-and-quicksearch.aspx?list_type=ncd
Centers for Medicare and Medicaid Services (CMS). (n.d.2). 100% MEDPAR inpatient hospital national data for fiscal year 2009. Accessed June 17, 2013 from: http://www.cms.gov/ Research-Statistics-Data-and-Systems/Statistics-Trends-andReports/MedicareFeeforSvcPartsAB/Downloads/DRG09.pdf
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part
Section 2 Clinical Classification Systems and Reimbursement Methods 159
Centers for Medicare and Medicaid Services (CMS). (n.d.3). Inpatient psychiatric prospective payment calculator. Accessed June 17, 2013 from:
http://www.cms.gov/Medicare/Medicare-Fee-for-Servicepayment/InpatientPsychFacilPPS/tools.html
Channel Publishing. (1999). Preparing for ICD-10-CM Video Series. Reno, NV.
Department of Health and Human Services (n.d.). Prescription drug coverage. Retrieved September 15, 2012, from http://medicare.gov/pdphome.asp
Devault, K. (2012). Best practices for coding productivity: Assessing productivity to prepare for ICD-10. Journal of AHIMA, 83(7),72–74.
Drach, M., Davis, A., & Sagrati, C. (2001). Ten steps to successful chargemaster reviews. Journal of AHIMA,72(1), 42–48.
Hamann, B. (2006). Disease identification, prevention, and control. New York: McGraw-Hill.
Hazelwood, A. C., & Venable, C. A. (2003). ICD-10-CM preview. Chicago: American Health Information Management Association.
Holland, R. P. (n.d.) Writing effective PRO rebuttals. Retrieved January 8, 2013, from http://www.irpsys.com/articles%5Crph_writ.htm.http://www.irpsys.com/articles.htm
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part
Section 2 Clinical Classification Systems and Reimbursement Methods 160
LaTour, K., Eichenwald-Maki, S., (2009). Health information management: Concepts, principles and practice (3rd ed.). Chicago: American Health Information Management Association.
Medicare. (n.d.). What Medicare Covers. Retrieved May 19, 2013 from http://www.medicare.gov/ what-medicare-covers/index.html
National Center for Health Statistics (NCHS). (n.d.1). A guide to state implementation of ICD-10 for mortality. Accessed June 17, 2013, from http://www.cdc.gov/nchs/icd/icd10.htm
National Center for Health Statistics (NCHS) (n.d.2). ICD-9-CM official guidelines for coding and reporting. Accessed June 17, 2013 from:http://www.cdc.gov/nchs/data/icd9/icd9cm_guidelines_2011.pdf
Neighbors, M., & Tannehill-Jones, R. (2000). Human diseases. Clifton Park, NY: Delmar Cengage Learning.
Office of Inspector General (OIG) (n.d.). Accessed June 17, 2013 from: http://oig.hhs.gov/fraud/docs/complianceguidance/012705HospSupplementalGuidance.pdf
Price, K., & Farley, D. (2005). How does your coding measure up? Analyzing performance data gives HIM a boost in managing revenue. Journal of AHIMA,76(7), 26–31.
Prophet, S. (2001). AHIMA practice brief: Developing a physician query process. Journal of AHIMA, 72(9), 88I–M.
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part
Section 2 Clinical Classification Systems and Reimbursement Methods 161
Sayles, N. (2013). Health information management technology: An applied approach (4th ed.). Chicago: American Health Information Management Association.
Schraffenberger, L. A. (2010). Effective management of coding services (4th ed.). Chicago: American Health Information Management Association.
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part
SECTION THREE Statistics and Quality Improvement
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Section 3 Statistics and Quality Improvement 163
CASE 3-1 Inpatient Service Days
Questions and Suggested Answers What would the inpatient service days for yesterday be? Calculation Census at midnight + admissions − discharges (includes deaths and transfers to another facility) 67 + 2 (admits) = 69
References Horton Johns Koch LaTour and Eichenwald-Maki
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Section 3 Statistics and Quality Improvement 164
CASE 3-2 Average Daily Census
Questions and Suggested Answers 1. What was the average daily census of adults and children for the year? (Round to a whole number.) Calculation:
Total inpatient service days for a period Total number of days in the period
Adults and children for the year:
75,860 + 7,100 365
=
82,960
= 227.287 = 227
365
2. What was the average daily census of newborns for the year? (Round to a whole number.)
Newborns:
11,800
= 32.32 = 32
365
References Horton Johns Koch LaTour and Eichenwald-Maki
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 3 Statistics and Quality Improvement 165
CASE 3-3 Length of Stay (LOS)
Questions and Suggested Answers Calculate the length of stay for each of these 2 patients. MR# 010362: Shows a patient who is admitted one month and discharged the subsequent month. The patient was admitted on March 24 and discharged on April 9. Calculate the LOS (i.e., number of days of stay) by subtracting the admit date of March 24 from the total number days in the month of March (31) and adding the number of days of stay in the subsequent month of April (9). March has 31 days, so subtract 24 from 31 to get total days in March: 31 − 24 = 7 Days in hospital in April: 9 LOS = 7 + 9 = 16 days MR# 120431: Shows a patient who was admitted and discharged (or died) on the same day (other examples: a 1-day stay, admission and discharge, or in and outs). The patient was admitted on July 12 and died July 12; the LOS = 1.
References Horton Johns Koch LaTour and Eichenwald-Maki © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 3 Statistics and Quality Improvement 166
CASE 3-4 Average Length of Stay (ALOS)
Questions and Suggested Answers Use the statistics reported in Table 3-2 for February to calculate the following: 1. What is February’s average length of stay for adults and children? (Round to 1 decimal place.) Total LOS (discharge days) Total discharges (includes deaths)
=
9, 457
=7
1, 351
2. What is February’s average daily census for adults and children? (Round to a whole number.) Total inpatient service days for a period (excluding newborns) 12,345 = = 440.89285 = 441 Total number of days in the period 28
3. What is February’s average length of stay for newborns? (Round to 1 decimal place.) Total newborn discharge days 231 = = 2.4838709 = 2.5 Total newborn discharges (includes deaths) 93
4. What is February’s average daily census for newborns? (Round to a whole number.) Total newborn inpatient service days for a period Total number of days in the period
=
553
= 19.72 = 20
28
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Section 3 Statistics and Quality Improvement 167
Table 3-2 South Houston General Hospital Inpatient Service Days South Houston General Hospital Inpatient Activity February Inpatient Activity Inpatient service days: Adult and pediatric Newborn Discharges: Adult and pediatric Newborn Discharge days: Adult and pediatric Newborn
Number of Patients 12,345 553 1,351 93 9,457 231
© 2014 Cengage Learning ®. All Rights Reserved.
References Horton Johns Koch LaTour and Eichenwald-Maki
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 3 Statistics and Quality Improvement 168
CASE 3-5 Percentage of Occupancy for Month
Questions and Suggested Answers Use the information in Table 3-3 to calculate the percentage of occupancy for adults and pediatrics in the month of March. (Round to a whole number.) Formula: Total inpatient service days in a period 100 Total bed count days in the period (bed count number of days in the period)
12, 345 100 500 31
=
1, 234, 500
= 79.64561 = 80%
15, 500
Table 3-3 Royal Palm Hospital Inpatient Service Days Royal Palm Hospital March 2013 Inpatient Activity
Number of Patients
Inpatient service days: Adult and pediatric Newborn
12,345 565
Discharges: Adult and pediatric Newborn
1,351 77
Discharge days: Adult and pediatric Newborn
9,457 231
© 2014 Cengage Learning ®. All Rights Reserved.
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Section 3 Statistics and Quality Improvement 169
References Horton Johns Koch LaTour and Eichenwald-Maki
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 3 Statistics and Quality Improvement 170
CASE 3-6 Percentage of Occupancy for Year
Questions and Suggested Answers Use the statistics in Table 3-4 to calculate the annual percentage of occupancy for the past year’s operations.
Formula:
Total inpatient service days in a period 100 (Bed count days) + (bed count days) + (bed count days)
Days in Each Month January
31
February
28
March
31
April
30
May
31
June
30
July
31
August
31
September
30
October
31
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Section 3 Statistics and Quality Improvement 171
November
30
December 31 Calculations for time periods:
January 1–May 31:
June 1–October 15:
28, 690 100 (31 + 28 + 31 + 30 + 31) 200 27, 400 100 (30 + 31 + 31 + 30 + 15) 250
October 16–December 31:
=
=
2, 869, 000 151 200
=
2, 869, 000 30, 200
2,740,000 2,740,000 = 137 250 34,250
19,250 100 1,925,000 1,925,000 = = (16 + 30 + 31) 275 77 275 21,175
Calculation for the year:
2,869,000 2,740,000 1,925,000 7,534,000 15,068,000 + + + = = 1568,00087.988321 = 88% 30,200 34,250 21,175 85,625 171,250
References Horton Johns Koch LaTour and Eichenwald-Maki
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 3 Statistics and Quality Improvement 172
CASE 3-7 Consultation Rate
Questions and Suggested Answers The hospital statistical data reported for the 300-bed hospital last year reflect: 20,932 discharges 136,651 discharge days 3,699 consultations performed Calculate the consultation rate for the year. (Round to 1 decimal place.)
Formula:
Total number of patients receiving consultation 100 Total number of patients discharged
Calculation:
3, 699 100 20, 932
=
369, 900
= 17.671507 = 17.7%
20, 932
References Horton Johns Koch LaTour and Eichenwald-Maki
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Section 3 Statistics and Quality Improvement 173
CASE 3-8 Nosocomial and Community-Acquired Infection Rate
Questions and Suggested Answers The hospital reports 1,652 discharges for September, and the infection control report documents that there were 21 nosocomial infections and 27 community-acquired infections for the same month. Calculate the nosocomial infection rate and the community-acquired infection rate. (Round to 2 decimal places.) Nosocomial infection rate
Formula:
Total number of nosocomial infections for a period 100 Total number of discharges for the same period (including deaths)
Calculation:
(21 100) 2100 = = 1.2711864 = 1.27% 1,652 1,652
Community-acquired infection rate
Formula:
Calculation:
Total number of community-acquired infections for a period 100 Total number of discharges for the same period (including deaths) (27 100) 1, 652
+
2,100
= 1.6343825 = 1.63%
1, 652
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Section 3 Statistics and Quality Improvement 174
References Horton Johns Koch LaTour and Eichenwald-Maki
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 3 Statistics and Quality Improvement 175
CASE 3-9 Incidence Rate
Questions and Suggested Answers During the month of August, 12 new cases of bird flu occurred. There were 4,000 people in the community who were at risk. Calculate the incidence rate for the month.
Formula:
Calculation:
Number of times something happened 100 Number of times something could have happened
12 100 4, 000
=
1, 200
= 0.3%
4, 000
References Horton Johns Koch LaTour and Eichenwald-Maki
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Section 3 Statistics and Quality Improvement 176
CASE 3-10 Comparative Heath Data: Hospital Mortality Statistics
Questions and Suggested Answers Use the statistics listed in Table 3-5 to calculate the gross mortality rate (rounded to 1 decimal place) for each retirement center. The gross mortality rate will be helpful to Bob and Pat in determining the most desired and least desired retirement center based on the importance they place on mortality rates from each facility (rounded to 1 decimal place). However, Bob and Pat should consider the level of care and services offered at each of the hospitals, because it could impact the outcomes of mortality incidence.
Formula:
Number of inpatient deaths in a period 100 Number of discharges in the same period (including deaths)
Northern Sea Breeze:
Great Plains City:
23 100 = 10.313901 = 10.3% 223
28 100
Rocky Mount Center:
South Beach Cove:
= 6.6985645 = 6.7%
418 32 100
= 14.88372 = 14.9%
215
29 100
= 9.090909 = 9.1%
319
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Section 3 Statistics and Quality Improvement 177
Table 3-5 Hospital Mortality Statistics
Hospital Mortality Statistics Hospital Name
Discharged Patients
Inpatient Deaths
Mortality Rates
223
23
10.3%
Great Plains City
418
28
6.7%
Rocky Mount
215
32
14.9%
319
29
9.1%
Northern Sea Breeze
Center South Beach Cove
© 2014 Cengage Learning ®. All Rights Reserved.
1. Based on this data, where will Bob and Pat choose to live? Explain why. The retirement community close to Great Plains City Hospital would be the most desired retirement center because it reflects the lowest mortality rate of 6.7%. 2. Which is the least desired? Explain why. The retirement community close to Rocky Mount Center Hospital would be the least desired retirement center because it reflects the highest mortality rate of 14.9%.
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Section 3 Statistics and Quality Improvement 178
References Horton Johns Koch LaTour and Eichenwald-Maki
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 3 Statistics and Quality Improvement 179
CASE 3-11 Joint Commission Hospital Quality Check
Questions and Suggested Answers 1. Select 3 hospitals closest to your affiliated school to research. For help in selecting the hospitals, visit http://www.jointcommission.org and search under the Quality Check icon. 2. Develop a critique of each of the 3 hospital’s most current surveys. Comment on significant areas of achievement and/or deficiency. Include the date of the most recent hospital survey and accreditation decision awarded. The instructor should review the student’s critique to see if any special recognition or awards each hospital may have achieved are listed. Ratings and/or comparisons on national patient safety goals and quality performance measures should also be included in the student critique. The hospitals’ last survey and accreditation decision should be listed. A sample hospital quality check comparison is provided in Table 3-11A.
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Section 3 Statistics and Quality Improvement 180
Table 3-11A Sample Hospital Quality Check Comparison
Hospital Quality Check Comparison Criteria
Hospital A
Hospital B
Survey Date
March 31, 2012
March 11, 2013
Accreditation
Accredited—Awarded
decision
healthcare organization that is
healthcare organization that is in
in
all
compliance with all standards at
standards at the time of the on-
the time of the on-site survey or
site survey or has successfully
has successfully addressed all
addressed
for
requirements for improvement
improvement within 90 days
within 90 days following the
following the survey
survey
compliance
to
with
requirements
2011–12,
hospital
Accredited—Awarded
2012–13,
this
a
In
safety goals
organization’s performance is
organization’s
similar to the performance of
similar to the performance of
most accredited organizations
most accredited organizations
2013 National quality
Heart
Heart
improvement goals
2011–Mar 2012 period) The
2012–Mar 2013 period) This
(core measures)
organization’s performance is
organization’s
similar to the performance of
below the performance of most
Care—(Apr
In
to
National patient
Failure
this
a
hospital
performance
Failure
is
Care—(Apr
performance
is
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Section 3 Statistics and Quality Improvement 181
most accredited organizations
accredited
both state and nationwide
state and nationwide
Pneumonia
Pneumonia Care—(Apr 2012–
Care—(Apr
organizations
2013
both
2011–Mar 2012 period) The
Mar
period)
This
organization’s performance is
organization's
performance
is
above the performance of most
below the performance of most
accredited organizations both
accredited
state and nationwide
However,
organizations. this
organization’s
performance statewide is similar Perinatal Care—(Apr 2011– to the performance of most Mar 2012 period) Not displayed accredited organizations Perinatal Care—(Apr 2012–Mar 2013 period) Not displayed Heart
Attack
Care—(Apr
2005–Mar 2013 period) This organization’s
performance
is
below the performance of most accredited
organizations
both
state and nationwide Surgical
Care
Improvement
Project—Hospital met national average in all SCIP areas except
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 3 Statistics and Quality Improvement 182
the following: (1) Surgical patients receiving antibiotic and stopped use within 24 hours (2) Removal of urinary catheter within
2
days
following
surgery Special
Certification Quality Report
Medal
certifications/awards
in Primary Stroke Center, Joint
Donation, ACS National Surgical
/recognition
Replacement
Quality Improvement Program,
(Hip),
Joint
of
Honor
for
Organ
Replacement (Knee)
and Gold Plus Get with the
Certification Quality Report—
Guidelines (Stroke) recognition
Received certification 3-31-12
award
© 2014 Cengage Learning ®. All Rights Reserved.
References Joint Commission on Accreditation of Healthcare Organizations (Joint Commission) LaTour and Eichenwald-Maki
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Section 3 Statistics and Quality Improvement 183
CASE 3-12 Nursing Home Comparative Data
Questions and Suggested Answers 3. Build a table of the quality measures and enter the percentage that each nursing home reflects in meeting the outcomes measurement. Students, answer may include compariative quality measures including pressure ulcers, influenza vaccine, pneumococcal vaccine, falls, urinary tract infections, incontinuent bowel or bladder, restraints, weight loss and/or depressive symptoms. 4. Based on your comparison, which would be your top choice in which to place your loved one? Students’ responses will be based on the nursing homes they searched and the performance measurements of each of those nursing homes.
References Centers for Medicare and Medicaid Services ( n.d. 1) Centers for Medicare and Medicaid Services (n.d. 2) Centers for Medicare and Medicaid Services (n.d. 3) Horton LaTour and Eichenwald-Maki
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Section 3 Statistics and Quality Improvement 184
CASE 3-13 Residential Care Facilities in Long-Term Care (LTC)
Questions and Suggested Answers After visiting the CDC website http://www.cdc.gov/nchs/ and reviewing the 2010 National Survey of Residential Care Facilities National Health Survey report, the student will select 3 of the following graphs to redevelop material to utilize in marketing their independent consultant services. Figure 1—Residential Care Facilities and Residents, by Facility Size Figure 2—Selected Characteristics of Residential Care Facilities, by Facility Size Figure 3—Residential Care Facilities, by Region and Facility Size Figure 4—Residential Care Beds per 1,000 Persons Age 85 and over by Region Figure 5—Residential Care Facilities Serving Any Resident Receiving LTC Services Paid by Medicaid Figure 6—Provision of Selected Services, by Facility Size
References Centers for Disease Control and Prevention (CDC) (n.d. 1) Horton LaTour and Eichenwald-Maki
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Section 3 Statistics and Quality Improvement 185
CASE 3-14 Relative Risk Comparison
Questions and Suggested Answers As a data collection specialist at the National Institutes of Health (NIH), you have been involved in a research study conducted over the past year. The study found that liver cancer rates per 100,000 males among cigarette smokers to nonsmokers, in a major urban U.S. city, were 48.0 to 25.4, respectively. In view of this data, what would be the relative risk of males in developing liver cancer for smokers compared to nonsmokers? (Round to 2 decimal places.) Number of times something happened 100
Formula:
Number of times something could have happened
Calculation:
48 100
= 0.048 % risk among cigarette smokers in a major urban U.S. city
100, 000
25.4 100
= 0.025 % risk among nonsmokers in a major urban U.S. city
100, 000
Reference Horton
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Section 3 Statistics and Quality Improvement 186
CASE 3-15 Determining Appropriate Formulas: Ratios
Questions and Suggested Answers You are helping the nursing department write evaluation criteria for an upcoming quality improvement study. You need to determine appropriate formulas for ratios and set data collection time frames. One important aspect of care is the documentation of education of patients. Specifically, the nursing department would like to assess its documentation compliance in education on colostomy care for patients receiving new colostomies. What would you suggest that they use for the numerator and denominator of the equation to gather their information? The formula for “Other Rates” should be applied in determining the rate of occurrence. Number of times something happened 100 Number of times something could have happened
This ratio would compare the number of times colostomy care was documented for a period of time (numerator) to the number of new colostomy patients treated (denominator) for the same period of time. Number of times colostomy care was documented for a period of time Number of new colostomy patients treated for the same period of time
Reference Horton
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Section 3 Statistics and Quality Improvement 187
CASE 3-16 Calculating Obstetrics (OB) Statistics
Questions and Suggested Answers Table 3-6 reflects the OB unit discharges for the month of January. Calculate the monthly obstetric cesarean section rate and the neonatal death rate for January. (Round to 2 decimal places.)
Cesarean section rate:
Calculation:
Neonatal death:
Calculation:
Total number of C-sections performed in a period 100 Total number of deliveries in the period (including C-sections) 13 100
= 28.88888 = 28.89% C - section Rate
45
Number of neonatal deaths during a period 1, 000 (Mortality) Rate : number of live births during the period 1 100
= 22.22222 = 22.22% neonatal death rate
45
References Horton Johns Koch LaTour and Eichenwald-Maki
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 3 Statistics and Quality Improvement 188
Table 3-6 January Discharge Data for the Obstetric Unit Obstetric Unit Newborn Discharge Data January MR#
Deliveries
Cesarean Section
Neonatal
Delivery Indicated (Y)
Death (Y)
001
1-1-13
Y
002
1-1-13
003
1-2-13
004
1-3-13
005
1-3-13
006
1-4-13
007
1-4-13
008
1-5-13
009
1-6-13
010
1-7-13
011
1-7-13
012
1-8-13
013
1-9-13
Y
014
1-9-13
Y
015
1-10-13
016
1-12-13
017
1-13-13
Y
Y
Y
Y
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Section 3 Statistics and Quality Improvement 189
018
1-13-13
019
1-14-13
020
1-14-13
021
1-15-13
022
1-15-13
023
1-15-13
024
1-16-13
025
1-16-13
026
1-17-13
027
1-17-13
028
1-18-13
029
1-18-13
030
1-20-13
031
1-21-13
032
1-22-13
033
1-22-13
034
1-23-13
035
1-24-13
036
1-24-13
037
1-26-13
038
1-27-13
039
1-28-13
040
1-28-13
Y
Y
Y
Y
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Section 3 Statistics and Quality Improvement 190
041
1-29-13
042
1-29-12
043
1-30-13
Y
044
1-31-13
Y
045
1-31-13
Y
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Section 3 Statistics and Quality Improvement 191
CASE 3-17 Research Cesarean Section Trend
Questions and Suggested Answers The student graphs will vary depending upon their home state. Each student should develop 2 tables utilizing data accessed from the “Recent Trends in Cesarean Delivery in the United States” from the CDC website. 1. Graph 1 Table 1 should report data of CS rates for the years of 1996 and 2007 from their home state, to compose a line graph reflecting CS rate comparisons for the respective years. 2. Graph 2 The second table should report percent of change in national CS rates from the respective years of 1996 and 2007. Then develop a bar graph to reflect the student’s home state percent of change comparable to the national percent of change for the time period. 3. Did your home state trend within 2% of the U.S. average rate? If not, why do you think your home state varies from the national trend? Each student’s answer will differ unless the instructor asks all of them to compare the same state.
References Centers for Disease Control and Prevention (CDC) (n. d. 2) Horton
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Section 3 Statistics and Quality Improvement 192
Johns Koch LaTour and Eichenwald-Maki
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Section 3 Statistics and Quality Improvement 193
CASE 3-18 Hospital Statistics Spreadsheet
Questions and Suggested Answers Access the spreadsheet given in the student companion website to access January discharge data. Utilizing the given spreadsheet, modify with formulas to automate the task of calculating month end statistics for administrative reporting. The spreadsheets created by your students to calculate the statistics will be different, but each of them should have as many formulas as possible in the spreadsheet to automatically calculate the requested statistics as reflected. The answers to the calculated statistics are reflected in Table 3-8. (See Case 3-18 Hospital Statistic Spreadsheet.xlsx in Student Companion online.) Table 3-8 Requested Monthly Statistics to Report
Requested Monthly Statistics to Report Statistics Requested
Statistics Reported
1. Total number of discharges
45
2. LOS (for each patient)
(calculated on spreadsheet for each discharged patient)
3. Total LOS (for all patients)
226
4. ALOS (for all patients)
5.02 days
(round to 2 decimal places)
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Section 3 Statistics and Quality Improvement 194
5. Gross death rate (round to 1
6.67 = 6.7
decimal place) 6. Net death rate (round to 1
4.55 = 4.6
decimal place) © 2014 Cengage Learning ®. All Rights Reserved.
ALOS formula:
Total length of stay (discharge days) Total discharges (including deaths)
Gross death rate formula: Number of inpatient deaths (including newborns) in a period 100 Number of discharges (including A & C and NB deaths) in the same period
Net death rate formula: Total number of inpatient deaths (including NB) minus deaths 48 hours of admission 100 Total number of discharges (including A & C and NB deaths) minus deaths 48 hours of admission
Reference Horton
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Section 3 Statistics and Quality Improvement 195
CASE 3-19 Benchmarks for Leading Causes of Death
Questions and Suggested Answers Access data from the Centers for Disease Control and Prevention (CDC) National Center for Health Statistics (NCHS) published listing the Ten Leading Causes of Death and Injury by Age Group for 2010. Create a spreadsheet utilizing Excel to calculate the percentage of the top 10 causes of death in 2010. Access data at: http://www.cdc.gov/injury/wisqars/pdf/10LCID_All_Deaths_By_Age_Group_2010-a.pdf The top 10 causes of death are shown in Table 3-19A. Develop a bar graph depicting the top 10 causes of death. A sample bar graph is presented in Figure 3-19A.
References Centers for Disease Control and Prevention (CDC) (n.d. 3) Horton Johns LaTour and Eichenwald-Maki
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Section 3 Statistics and Quality Improvement 196
Table 3-19A Top 10 Causes of Death for 2010
Top 10 Causes of Death for 2010 Number Rank
Causes of Death
of Deaths
% Deaths
1 Heart disease
597,689
32
2 Malignant neoplasms
574,743
31
3 disease
138,080
7
4 Cerebrovascular
129,476
6
5 Unintentional injury
120,859
6
6 Alzheimer’s disease
83,494
5
7 Diabetes mellitus
69,071
4
8 Nephritis
50,476
3
9 Influenza & pneumonia
50,097
3
10 Suicide
38,364
3
Chronic lower respiratory
1,852,349 10000.00% © 2014 Cengage Learning ®. All Rights Reserved.
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Section 3 Statistics and Quality Improvement 197
Figure 3-19A Top 10 Causes of Death for 2010
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Section 3 Statistics and Quality Improvement 198
CASE 3-20
Death Trends for Heart and Malignant Neoplasms Questions and Suggested Answers Use the data retrieved from the table on the CDC website to develop 2 line graphs reflecting mortality incidence from a selected age category on the top 2 causes of death, heart and malignant neoplasms, for the period from 2005 through 2009. Sample line graphs are presented in Figures 3-20A and 3-20B.
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Section 3 Statistics and Quality Improvement 199
© 2014 Cengage Learning ®. All Rights Reserved.
Figure 3-20A Death Trend Due to Heart Disease Age 45–54 to Age Adjusted Rate per 100,000
Figure 3-20b Death Trend Due to Malignant Neoplasms Age 65–74 to Age Adjusted Rate Per 100,000
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Section 3 Statistics and Quality Improvement 200
References Centers for Disease Control and Prevention (CDC) (n.d. 4) Centers for Disease Control and Prevention (CDC) (n.d. 5) Horton Johns LaTour and Eichenwald-Maki
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Section 3 Statistics and Quality Improvement 201
CASE 3-21 Principal Diagnosis and Principal Procedures for U.S. Hospitalizations
Questions and Suggested Answers Utilizing the student companion website, the student is to access the Agency for Healthcare Research and Quality (AHRQ) national statistic database at http://www.hcupus.ahrq.gov/reports/factsandfigures/2009/TOC_2009.jsp, to abstract data from HCUP Facts and Figures 2009—Section 2, Inpatient Hospital Stays by Diagnosis and Section 3, Inpatient Hospital Stays by Procedure. Review Exhibit 2.2 from the HCUP report on Most Frequent Principal Diagnosis. Develop a pareto chart graph reflecting the 5 most frequent principal diagnosis for hospital stays in 2009. 2. Review Exhibit 3.1 from the HCUP report on Most Frequent All Listed Procedures. Develop a pareto chart graph indicating the top 5 procedures reflecting the number of hospital stays for 2009. Sample graphs are presented in Figures 3-21A and 3-21B.
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Section 3 Statistics and Quality Improvement 202
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Figure 3-21A Top Principal Diagnosis for Hospital Stays in 2009
Figure 3-21B Top Procedures for Hospital Stays in 2009
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Section 3 Statistics and Quality Improvement 203
References Agency for Healthcare Research and Quality (AHRQ) (n.d. 1) Horton Johns LaTour and Eichenwald-Maki
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Section 3 Statistics and Quality Improvement 204
CASE 3-22 Diagnosis-Related Groups (DRGs) and Revenue
Questions and Suggested Answers The CMS has increased the weight for DRG A by 14%, increased the weight for DRG B by 20%, and decreased the weight for DRG D by 10%. Given these new weights, which DRG generated the most revenue for Rocky Top Hospital? The students should discover that the relative weight assigned for a DRG, under Medicare’s acute care prospective payment system, represents the average resources required to care for that type of case (DRG) in comparison to the national average of resources used in treating all Medicare patients. Therefore, a patient with a DRG 2.000 requires twice as many resources as a DRG with a relative weight of 1.000. The CMI is calculated by multiplying the number of cases for each DRG by the relative weight of the DRG. The student can analyze the results to determine which DRG has the highest extended relative weight and generated revenue for Rocky Top Hospital. Table 3-9 provides a summary of the calculations shown. Part I: DRG weight calculations before weight changes DRG A = 323 × 2.0230 = 653.4290 DRG B = 489 × 0.9870 = 482.6430 DRG C = 402 × 1.9250 = 773.8500 DRG D = 386 × 1.2430 = 479.7980
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Section 3 Statistics and Quality Improvement 205
Part II: DRG weight calculations after the weight changes DRG A increased relative weight by 14% 2.0230 ×.14 = 0.28322 2.0230 + 0.28322 = 2.30622 new weight New DRG A weight calculation = 323 × 2.30622 = 744.90906 DRG B increased relative weight by 20% 0.9870 ×.20 = 0.1974 0.9870 + 0.1974 = 1.1844 new weight New DRG B weight calculation = 489 × 1.1844 = 579.1716 DRG C (no change in weight) 402 × 1.9250 = 773.8500 DRG D increased relative weight by 10% 1.2430 ×.10 = 0.1243 1.2430 + 0.1243 = 1.3673 new weight New DRG D weight calculation = 326 × 1.3673 = 445.7398
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Section 3 Statistics and Quality Improvement 206
Table 3-9 Rocky Top Hospital Highest Volume DRGs (with Updated Weights)
Rocky Top Hospital Highest Volume DRGs DRG A
DRG B
DRG C
DRG D
CMS
Number of
CMS
Number of
CMS
Number of
CMS
Number of
Weight
Patients
Weight
Patients
Weight
Patients
Weight
Patients
2.3062
323
1.1844
489
1.9250
402
1.3673
386
Extended weight
Extended weight
Extended weight
Extended weight
before weight changes
before weight changes
before weight changes
before weight changes
653.4290
482.6430
773.8500
479.7980
Extended weight
Extended weight
Extended weight
Extended weight
after weight changes
after weight changes
after weight changes
after weight changes
744.9091
579.1716
773.8500
445.7398
© 2014 Cengage Learning ®. All Rights Reserved.
1. Which of the DRGs listed in Table 3-9 generated the most revenue for Rocky Top Hospital? DRG C has the highest extended relative weight at 773.8500 and generated the highest revenue before changes in relative weights.
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Section 3 Statistics and Quality Improvement 207
2. CMS has increased the weight for DRG A by 14% and for DRG B by 20%. The weight for DRG D was decreased by 10%. Given these DRG weight changes, which DRG generated the most revenue for Rocky Top Hospital? After the increase in relative weight to DRGs A, B, and D was implemented, DRG A at an extended relative weight of 744.9091 generated the highest revenue.
References LaTour and Eichenwald-Maki
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Section 3 Statistics and Quality Improvement 208
CASE 3-23 DRG 110 versus DRG 111 Cost Analysis (DRG version 10)
Questions and Suggested Answers Utilizing this historical DRG data given in the table, what are the financial implications in cost between DRG 110 (major cardiovascular procedure with CC) in comparison to DRG 111 (major cardiovascular procedure without CC), if 10% more of the discharges had complications or comorbidity conditions diagnosed? For the instructor, an excerpt from the Nationwide Inpatient Sample for 1994 Hospital Inpatient Stays, with information on DRG 110 and DRG 111, is provided in Table 3-23A.
Table 3-23A
Excerpt from DRG Statistics (from the HCUP-3 Nationwide Inpatient
Sample for 1994: Diagnosis-Related Groups)
Statistics from the Nationwide Inpatient Sample for 1994 Hospital Inpatient Stays
Diagnosis-Related Groups Total % of Total Mean total (DRGs) (Version 10) Discharges Discharges Mean LOS Charges
110 Major cardiovascular 103,680 0.30 10.86 40,052 procedures w/CC 111 Major cardiovascular 13,853 0.04 6.29 22,612 procedures w/o CC © 2014 Cengage Learning ®. All Rights Reserved.
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Section 3 Statistics and Quality Improvement 209
The impact of having 10% more DRG 110 (major cardiovascular procedure w/CC) cases would be significant to the organization. Note that there were a total of 13,853 discharges from DRG 110 and 103,680 discharges from DRG 111 cases. A 10% increase in DRG 110 cases would increase the number of discharges in DRG 110 by 1,385 to a total of 15,238 discharges. To determine the financial impact from the given data, first multiply the average charge for DRG 110 by 1,385 MORE cases. The charges per case in DRG 110 are $40,052. Multiply the 1,385 ADDITIONAL cases times $40,052 per case for total increase of $55,472,020. Calculations: 13,853 ×.10 = 1,385 additional cases 13,853 + 1,385 = 15,238 cases 15,238 × $40,052 = $55,472,020 increase Then, decrease the number of cases in DRG 111 by 1,385 cases. Multiply the charge for DRG 111 by 1,385 to arrive at the total decrease in cost for the decrease in total cases. The charge for DRG 111 is $22,612. Multiply the 1,385 FEWER cases times $22,612 per case for a total decrease of $31,317,620. Calculations: 1,385 × $22,612 = 31,317.620 decrease These calculations are summarized in Table 3-23B. Finally, the net difference in revenue would be a $55,472,020 increase in DRG 110, minus the $31,317,620 decrease in DRG 111. Calculation:
$55,472,020 − $31,317,620 = $24,154,400 increase
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Section 3 Statistics and Quality Improvement 210
Or, you could multiply the 1,385 cases by the difference in charges between the 2 DRGs (40,052 − 22,612), which would be $17,440 more per case, to arrive at an increase of $24,154,400.
Calculation:
1,385 × ($40,052 − $22,612) = $24,154,400.
Or 1,385 × $17,440 = $24,154,400. Table 3-23B provides a summary of these calculations. Table 3-23B Summary of Calculations for a 10% Increase in DRG 110
Summary of Calculations for a 10% Increase in DRG 110 DRG
10% Change in
Charge per Case
Number of Cases
Charges for 10% Difference
110
+1385
$40,052
+$55,472,020
111
–1385
–$22,612
–$31,317,620
$17,440
$24,154,400
Increase in charges © 2014 Cengage Learning ®. All Rights Reserved.
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Section 3 Statistics and Quality Improvement 211
References Agency for Healthcare Research and Quality (AHRQ) (n.d. 2) Johns LaTour and Eichenwald-Maki
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Section 3 Statistics and Quality Improvement 212
CASE 3-24 Calculating Physician Service Statistics
Questions and Suggested Answers Table 3-10 shows some statistics reported on the physicians’ services at Pike’s Peak Clinic last Tuesday. Table 3-10 Pike’s Peak Clinic Physician Services Statistics for Tuesday Pike’s Peak Clinic Physician Service Statistics for Tuesday Physician
Service A
Service B
Service C
Truba
10
18
14
Wooley
14
22
9
Howe
18
5
6
Masters
12
20
7
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It takes twice as long to perform Service C, so the physicians are proposing that Service C should count as 2 services for the purpose of calculating workload. If Service C counts twice as much as Service A or Service B, which physician provided the most services on Tuesday? Performance measurement involves the management functions of planning and controlling for adequate resources. A work measurement study can be performed to determine the time required to perform each of the services in establishing fees, with Service C counting as 2 units of service.
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Section 3 Statistics and Quality Improvement 213
However, the work measurement study should be repeated at a later time, because good management requires more than 1 study to base decisions on. Various factors could impact an individual’s performance on a particular day, so to eliminate any variances in results obtained in the study it should be repeated. Calculation with each Service C counting as 2 units of service: •
Dr. Truba’s services provided calculates: 10 + 18 + (14 × 2) = 28 + 28 = 56.
•
Dr. Wooley’s services provided calculates: 14 + 22 + (9 × 2) = 36 + 18 = 54.
•
Dr. Howe’s services provided calculates: 18 + 5 + (6 × 2) = 23 + 12 = 35.
•
Dr. Masters’s services provided calculates: 12 + 20 + (7 × 2) = 32 + 14 = 46.
These calculations determine that Dr. Truba provided the most services on Tuesday.
References Johns LaTour and Eichenwald-Maki
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Section 3 Statistics and Quality Improvement 214
CASE 3-25 Determining the Percentage of Patients with Unacceptable Waiting Time
Questions and Suggested Answers Use the information in Table 3-11 to calculate the average percentage of patients for the year who were delayed longer than an acceptable waiting time? (Round to 1 decimal place.) Table 3-11 Percent of Patients with Unacceptable Waiting Time Patients with Unacceptable Waiting Time Month
Percent
January
5%
February
4%
March
3%
April
5%
May
3%
June
10%
July
5%
August
2%
September
1%
October
2%
November
1%
December
3%
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Section 3 Statistics and Quality Improvement 215
The sample size of 100 patients each month makes calculations relatively easy. Students will multiply each month’s percent by 100 to determine how many patients experienced an unacceptable wait time for the year. This would become the numerator in the formula for calculating the annual unacceptable wait time. The denominator would be the total number of patients tracked in the annual study, or 1,200, since 100 patients were tracked each month for the past 12 months of the year. Formula:
Annual unacceptable waits
= Number of patients with unacceptable wait time for year
Total patient sample size
Calculation:
44 100
= 3.666 = 3.7% patients with unacceptable wait time for year
1, 200
Reference LaTour and Eichenwald-Maki
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Section 3 Statistics and Quality Improvement 216
CASE 3-26 Systems Analysis of Health Information Management (HIM) Function from Clinical Experience
Questions and Suggested Answers Develop a flowchart. Microsoft Word has functionality to draw flowcharts, so you may choose to use MS Word or Visio software in completing your flowchart. You may want to visit the Microsoft Office Internet website at http://office.microsoft.com/training to search for tips or training material on flowcharting. Accompany your flowchart with a written procedure of the process. Students’ flowcharts and procedures will depend upon individual facility, function chosen, and work processes.
References Johns LaTour and Eichenwald-Maki Microsoft Office
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Section 3 Statistics and Quality Improvement 217
CASE 3-27 Clinical Quality Improvement Literature Research
Questions and Suggested Answers Perform a literature search on clinical quality management (i.e., clinical quality improvement or clinical performance improvement) for articles presenting actual clinical quality improvement (QI) studies performed in a healthcare facility. Select an article of a QI study performed to present and discuss the problem or process it sought to improve. In your presentation, include as many of the following elements as possible regarding the QI study performed: •
The problem or risk identified
•
Why the topic was chosen for study
•
Current method or process of performance
•
Alternative methods of improvement considered
•
Selected alternative to implement
•
Implementation
•
Monitoring or follow-up of the results
This exercise provides the student an opportunity to practice research skills and to develop presentation graphics and experience in oral reporting. The bonus is that your HI class receives different perspectives on story boarding and an overview of various QI studies.
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Section 3 Statistics and Quality Improvement 218
References Johns LaTour and Eichenwald-Maki Shaw, Isaacson, and Murphy
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Section 3 Statistics and Quality Improvement 219
CASE 3-28 Quality Improvement (QI)/Performance Improvement (PI) Interview Project
Questions and Suggested Answers Contact a quality improvement department at a healthcare facility to interview a staff representative of a QI/PI project performed by the facility. 1. Develop a storyboard display of the QI/PI study project. 2. Present an oral presentation describing the QI project conducted and overview reflecting the mission, vision, customers and expectations, findings, and recommendations. The presentation should last approximately 10 minutes and allow 5 maximum additional minutes for questions and answers. This exercise provides the student an opportunity to practice performing interviews and to develop presentation graphics and oral presentations. The bonus is that your HI class receives different perspectives on story boarding and an overview of various QI studies.
Reference Shaw, Isaacson, and Murphy
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Section 3 Statistics and Quality Improvement 220
CASE 3-29 Research Report Utilizing NCHS Public Database Questions and Suggested Answers You work for a large teaching hospital affiliated with a college having Masters and Baccalaureate degree programs in Health Information Management and Informatics (HIM). You have been asked to speak with the HIM students about your role in assisting the physicians and intern medical students in conducting research utilizing patient record data. Often, the research projects lead to accessing benchmark data for comparison. As part of your presentation, you offer the students access to the public database with the National Center for Health Statistics (NCHS) to vital statistics as a resource for benchmark data. Visit the web links section of the student companion website for access to the database. 1. Select a topic of interest from the tables offered in the database and customize your search to obtain findings of your selected group population. 2. Print a chart diagram (graph) of the customized report. 3. Write a paragraph that briefly summarizes your graphed findings. Each student’s report summary and graph will differ.
Reference Centers for Disease Control and Prevention (CDC) (n.d. 5) http://www.cdc.gov/nchs/hdi.htm
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Section 3 Statistics and Quality Improvement 221
CASE 3-30 Septicemic Hospitalizations as Principal Diagnosis vs. Secondary Diagnosis
Questions and Suggested Answers Students are to access AHRQ Septecemia in U.S. Hospitalizations, 2009, Statistical Brief Report #122 to research benchmark data as a research data analyst. (http://www.hcupus.ahrq.gov/reports/statbriefs/sb122.pdf) 1. Determine the top 4 septicemic infections by organism. 2. Develop a graph of the top 4 septicemia infectious organisms as principal diagnosis in comparison to the same organism as secondary diagnosis from 2009 hospitalizations.
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A sample graph is presented in Figure 3-30A.
Figure 3-30A Leading Septicemic Infections in 2009 Hospital Stays
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Section 3 Statistics and Quality Improvement 222
Reference Agency for Healthcare Research and Quality (AHRQ) (n.d. 3)
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Section 3 Statistics and Quality Improvement 223
CASE 3-31 Pain Assessment Study
Questions and Suggested Answers Review the established pain classification system in Table 3-12 and respond to the questions presented. 1. What type of data does the table represent? These are ordinal data because they are ranked or are in an order. They are ordinal because they are specified within a numbered series from 01 to 10. 2. Explain why these data differ from other categorical data and why the data are appropriate to use with this Pain Assessment Study. These data differ from nominal data because these data are not ordered or ranked. Nominal is simply a label usually representing or identifying to define a group. Nominal data do not allow arithmetic operation or calculations. Table 3-12 Pain Assessment Study Pain Level Scale Documented Pain Description Pain Level Range 01–02
None or occasional
03–04
Little or minimal
05–06
Moderate
07–08
Heavy
09–10
Severe
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Section 3 Statistics and Quality Improvement 224
References Abdelhak
Horton Koch McWay
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Section 3 Statistics and Quality Improvement 225
CASE 3-32 Coronary Artery Bypass Graft Postoperative LOS
Questions and Suggested Answers 1. What is the mean postoperative length of stay (PLOS) for the CABG cases from the 3rd quarter? The arithmetic mean is 8.5 days. 2. What is the median PLOS for the CABG cases from the 3rd quarter? The median is the midpoint of the distribution of values. This may be statistically represented as the point above and below which 50% of the values fall. This will require placing the values in ordinal rank or ascending order to determine the middle value. If there are an odd number of values, simply choose the middle value. If there are an even number of values, choose the 2 middle values and find their average to determine the median PLOS. In the table given, there are 19 values with the middle-most value being 7. 3. Is there an LOS outlier that skewed the mean LOS from the 3rd quarter? The value of 25 was an extreme outlier in the distribution of values. The value of 14 was also an outlier in the distribution. 4. Plot each LOS on a line graph, with the LOS represented on the Y axis. Figure 3-32A provides a sample graph. 5. What conclusion can you draw regarding the graph? The LOS value of 25 as well as the 14 LOS are outlier postop LOS from the average CABG patient. Although there were only 19 values given, it is obvious these are outliers from the graph.
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Section 3 Statistics and Quality Improvement 226
Figure 3-32A CABG Postoperative LOS
References Abdelhak Horton Koch
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Section 3 Statistics and Quality Improvement 227
CASE 3-33 Skyview Hospital Monthly Statistical Report
Questions and Suggested Answers 1. What is May’s Average Length of Stay (ALOS)? The ALOS is 4.76. This was calculated by dividing the total LOS (discharge days) by the total number of discharges (including deaths). So the student should calculate 4,478/940 = 4.76. 2. What is the ALOS for each hospital service for May? a. Medicine—1915/315 + 18 = 1915/333 = 5.75 b. Obstetric—278/132 + 2 = 278/134 = 2.07 c. Gynecology—401/102 + 1 = 401/103 = 3.89 d. Urology—761/92 + 3 = 761/95 = 8.01 e. Newborns—405/126 + 1 = 405/127 = 3.18 1. What is the Percentage of Occupancy (aka Bed Occupancy Ratio)? Apply formula:
Total inpatient service days in a period × 100 Total bed count days in the period ( bed count × number of days in the period ) a. For adults and children—396 × 100/30 × 31 = 39,600/930 = 42.58 b. For newborns—4152 × 100/225 × 31 = 415,200/6975 = 59.52
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Section 3 Statistics and Quality Improvement 228
Table 3-14 Skyview Monthly Statistical Report Skyview Monthly Statistical Report Live Service
Admits
Inpatient
Discharge
Service Days
Days
Deaths Discharges
Medicine
325
315
18
1,950
1,915
Surgery
146
143
5
730
718
Obstetric
130
132
2
290
278
Gynecology
105
102
1
408
401
Urology
98
92
3
774
761
Newborn
122
126
1
396
405
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References Abdelhak Horton Koch
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Section 3 Statistics and Quality Improvement 229
References Abdelhak, M., Grostick, S., & Hanken, M. A. (Eds.). (2012). Health information: Management of a strategic resource (4th ed.). Philadelphia: Elsevier. Agency for Healthcare Research and Quality (AHRQ). (n.d. 1). National statistics archive. Accessed October 25, 2012, from http://www.hcupus.ahrq.gov/reports/factsandfigures/2009/TOC_2009.jsp Agency for Healthcare Research and Quality (AHRQ). (n.d. 2). Accessed October 25, 2012, from http://www.hcup-us.ahrq.gov/overview.jsp; http://www.hcupus.ahrq.gov/reports/natstats/94drga.htm#110 Agency for Healthcare Research and Quality (AHRQ). (n.d. 3). Statistical brief # 123. Accessed May 21, 2013, from http://www.hcup-us.ahrq.gov/reports/statbriefs/sb122.pdf Centers for Disease Control and Prevention (CDC). (n.d. 1). Accessed May 21, 2013, from http://www.cdc.gov/nchs/; http://www.cdc.gov/nchs/nsrcf.htm; http://www.cdc.gov/nchs/data/databriefs/db78.pdf Centers for Disease Control and Prevention (CDC). (n.d. 2). Recent trends in cesarean delivery in the United States. NCHS Data Brief, No. 35, March 2010. Accessed May 21, 2013, from http://www.cdc.gov/nchs/data/databriefs/db35.pdf Centers for Disease Control and Prevention (CDC). (n.d. 3). The Ten Leading Causes of Death by Age Group, United States—(2010). Accessed May 21, 2013, from http://www.cdc.gov/ injury/wisqars/pdf/10LCID_All_Deaths_By_Age_Group_2010-a.pdf
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Section 3 Statistics and Quality Improvement 230
Centers for Disease Control and Prevention (CDC). (n.d. 4). Deaths: Final data for 2009. National Vital Statistics Reports, 60(3). Accessed May 21, 2013, from http://www.cdc.gov /nchs/data/nvsr/nvsr60/nvsr60_03.pdf Centers for Disease Control and Prevention (CDC). (n.d. 5). Health data interactive. Accessed May 21, 2013, from http://www.cdc.gov/nchs/hdi.htm Centers for Medicare and Medicaid Services. (n.d. 1). Data collection in long-term care: Minimum data. Accessed August 21, 2012, at http://www.cms.gov/Medicare/QualityInitiatives-Patient-AssessmentInstruments/NursingHomeQualityInits/NHQIMDS30TrainingMaterials.html Centers for Medicare and Medicaid Services. (n.d. 2). MDS3 interdisciplinary team. CMS Training Videos on You Tube. Accessed October 25, 2012, from http://www.youtube.com/ watch?v=cmBeuxSnbUs Centers for Medicare and Medicaid Services. (n.d. 3). Video on Interviewing Vulnerable Elders (VIVE). CMS Training Videos on You Tube. Accessed October 25, 2012 at http://www.youtube.com/watch?v=Ereawm4_F7k&lr=1&feature=mhum Horton, L. (2010). Calculating and reporting healthcare statistics (4th ed.). Chicago: American Health Information Management Association. Johns, M. (Ed.). (2011). Health information management technology: An applied approach (3rd ed.). Chicago: American Health Information Management Association. Joint Commission on Accreditation of Healthcare Organizations (Joint Commission). (n.d.). Accessed May 21, 2013, from http://www.jointcommission.org; http://www.jointcommission.org/performance_measurement.aspx;
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Section 3 Statistics and Quality Improvement 231
http://www.jointcommission.org/search/default.aspx?Keywords=guide+to+using+the+joint+ commission+hospital+quality+report&sitename=Joint+Commission&guid=6c6e42150fb14f2 5814e155eed5ec215&f=sitename%2cbrand&brand=Hospitals; http://www.qualitycheck.org/help_about_qc.aspx Koch, G. (Ed.). (2008). Basic allied health statistics and analysis (3rd ed.). Clifton Park, NY: Delmar Thomson Learning. LaTour, K., & Eichenwald-Maki, S. (Eds.). (2010). Health information management concepts, principles, and practice (3rd ed.). Chicago: American Health Information Management Association. Microsoft Office. (n.d.). Microsoft office online, overview—Training. Accessed October 25, 2012, from http://office.microsoft.com/training; http://office.microsoft.com/en-us/trainingFX101782702.aspx Shaw, P., Issacson, C., & Murphy, E. (2012). Quality and performance improvement in healthcare (5th ed.). Chicago: American Health Information Management Association.
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SECTION FOUR Healthcare Privacy, Confidentiality, Legal, and Ethical Issues
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Section 4 Healthcare Privacy, Confidentiality, Legal, and Ethical Issues 233
CASE 4-1 Notice of Privacy Practices
Questions and Suggested Answers Review the Notice of Privacy Practices shown in Figure 4-1. What problems do you identify with this Notice of Privacy Practices? The following problems should be identified by the student: •
It does not tell the patient that he or she has the right to request an amendment.
•
The rights listed do not tell the patient how to exercise these rights.
•
There are no examples of treatment, payment, and healthcare operations.
•
A request for accounting of disclosure can be issued anytime—not 5 years as stated in the Notice of Privacy Practices provided in this case.
References Hartley Hughes (2002) LaTour and Eichenwald-Maki Roach Sayles
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Section 4 Healthcare Privacy, Confidentiality, Legal, and Ethical Issues 234
CASE 4-2 Accounting for Disclosure of Protected Health Information (PHI) under the Health Insurance Portability and Accountability Act
Questions and Suggested Answers 1. What HIPAA issues apply to this case study? The facility only has to report accesses to the protected health information (PHI) since the implementation date of the HIPAA Privacy Rule on April 14, 2003. The first request for an accounting of disclosure in a 12-month period is free, but the facility can charge for a second within 12 months. The charge has to be reasonable based on costs. A routine charge of $150 would not be considered reasonable. In addition, if a fee is to be assessed, the patient needs to be notified in advance. 2. What information would you include in the accounting of disclosure? Date of release, name and address to which the PHI is to be sent, description of information sent, and a description of the purpose. 3. How will you handle this situation? Process the request; the facility cannot charge the patient since it has been longer than 12 months since the last request for an account of disclosure.
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Section 4 Healthcare Privacy, Confidentiality, Legal, and Ethical Issues 235
Table 4-1
Disclosures of PHI Disclosures of PHI
Released to
Date of Request
Authorized by
Attorney
3/7/06
Patient
Attorney
3/2/06
TPO
Physician
2/15/05
Patient
Physician
1/13/05
TPO
Blue Cross
2/11/11
TPO
Patient
12/17/05
Patient
Health Department
7/12/04
Law
Subpoena
1/19/05
Law
Researcher
12/28/05
Patient
Prison official
11/19/05
Law
Evaluation
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References Dougherty Hartley LaTour and Eichenwald-Maki Roach Sayles
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Section 4 Healthcare Privacy, Confidentiality, Legal, and Ethical Issues 236
CASE 4-3 Legal Issues in Accounting for Disclosure of Protected Health Information (PHI) to the Health Department
Questions and Suggested Answers 1. What are George’s legal rights? He has the right to file a complaint but cannot force the facility to amend the record if the originator believes the information to be true. 2. What are the hospital’s legal responsibilities to the state health department and to George? Any complaint filed must be investigated. The facility also must report communicable diseases as required by the state. 3. What response would you expect from the hospital and the Office of Inspector General (OIG)? The response from both of them would be that this was not a privacy violation because this was released according to state law and is allowed by HIPAA. 4. Was filing a privacy complaint the best suggestion the administrator could have given the patient to pursue? This was not the best suggestion. The administrator should have explained the mandatory reporting law to the patient instead of telling him to report this as a privacy violation. The administrator could have pulled up the website listing the mandatory reporting diseases and process and printed it for the patient, or given the URL to the patient for review later. Explaining why it was done could have saved a lot of time and energy for both the facility and the patient.
References Hartley LaTour and Eichenwald-Maki Roach Sayles
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Section 4 Healthcare Privacy, Confidentiality, Legal, and Ethical Issues 237
CASE 4-4 Patient’s Right to Amend Record
Questions and Suggested Answers Critique the responses to Martha’s request for changing the hospital’s medical record. Both the ROI coordinator and the director were incorrect in their response. HIPAA privacy rules give Martha the right to request the amendment. The hospital is required to review the request and approve the change if the original documenter agrees. Some statements in the medical record could be a matter of opinion, but the type of blood a patient has should be relatively easy to confirm. If the blood type is incorrect, one would expect the hospital to approve the change. Both the ROI coordinator and the HIM director would need to be educated on the rights that Martha was awarded by HIPAA. They need to know not only the rights of the patient but also the facility policy and procedure for this process.
References Hartley Hughes (2001) Roach Sayles Thieleman
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Section 4 Healthcare Privacy, Confidentiality, Legal, and Ethical Issues 238
CASE 4-5 Institutional Process for Patient Request to Amend Record
Questions and Suggested Answers How would you revise the form shown in Figure 4-2 to ensure that you are compliant with all privacy regulations and have adequate communication via the form? Utilize good form design principles. There are a variety of changes that the student could suggest. Some examples of changes that could be made are found in Figure 4-5A.
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Section 4 Healthcare Privacy, Confidentiality, Legal, and Ethical Issues 239
Figure 4-5A Internal Form for Patient Request for Health Record Amendment
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Section 4 Healthcare Privacy, Confidentiality, Legal, and Ethical Issues 240
CASE 4-6 Alteration of Patient Record
Questions and Suggested Answers 1. What issues are involved in this situation? The clerk should have notified the HIM director and risk management of the discrepancies with medication allergies when they were observed. The chart should have been placed under strict control so that the record could not be altered. The alteration will need to be reported to risk management now. 2. What process should be implemented to prevent this problem from happening again? The students could come up with a number of options (see examples in the following list): •
Policy and procedures could be updated to require that while the patient is in-house, nursing and/or pharmacy must check the chart for any drug allergies—not just rely on physician’s documentation.
•
There could be a policy that requires potentially compensable events to be reported to risk management immediately and for the chart to be sequestered until an investigation can be conducted.
References LaTour and Eichenwald-Maki Pozgar Roach Sayles
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Section 4 Healthcare Privacy, Confidentiality, Legal, and Ethical Issues 241
CASE 4-7 Investigating Privacy Violations
Questions and Suggested Answers Review each of the privacy incidents described in the following list. Determine which ones are privacy violations. Determine to whom the privacy violation should be reported and the timing required for the notifications. 1. Some alcohol and drug abuse records were inadvertently left accessible via the Internet. Fifty patients were affected. This is a violation that must be investigated to determine how this incident happened. The investigation would include obtaining an audit trail. The facility would also need to investigate if the information was accessed. The patients involved would need to be notified, and any problems mitigated. 2. A patient overheard a physician telling another patients’ family that the cancer had spread to the surrounding lymph nodes. The physician was talking in a low voice in a corner of the hallway. This is not a violation. This would be considered an incidental disclosure. 3. A hacker accessed your lab system and viewed multiple records. This is a violation that must be investigated. The appropriate authorities would need to be brought in to assist in tracking who accessed this information. They would also need to determine the system weakness that was taken advantage of so that they can go back and correct the situation to see that it does not happen again. 4. A single form from a different patient was sent to the requesting patient. This is a violation that must be investigated. The person responsible for the breach would need to be identified. Any disciplinary actions should be as per policy. Steps would need to be taken to mitigate any problems that the patient might encounter. 5. A computer was not logged off and a visitor looked up his mother’s PHI. This is a violation that must be investigated. You would need to research who did not log off the system so that an unauthorized user could access the system. Facility policy would need to be followed to implement any disciplinary actions. Mitigation would also need to occur.
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Section 4 Healthcare Privacy, Confidentiality, Legal, and Ethical Issues 242
6. A monitor is turned toward the reception desk so that anyone who walks by can see it. This is a violation that must be investigated. The monitor would need to be turned in such a way as to prevent unauthorized users from viewing PHI. The chief information officer (CIO) may want to monitor this workstation to ensure that the monitor is not turned back around. 7. A patient complained that his ex-wife looked at his record and told his girlfriend that he had human immunodeficiency virus (HIV). This is a violation that must be investigated. The steps to be taken would be different based on the paper or electronic media. If it is a paper environment, one would have to look at the chart locator and other resources to determine if the employee had the opportunity to access the PHI. In an electronic system, the audit log would tell if the employee had looked up the patient. You would also need to determine if the employee had access to the information in other ways, such as a report. Once the facility has ruled on their findings, the patient would need to be notified of the results—appropriate actions have been taken or no evidence to support the accusation. If the employee is found guilty, then the appropriate steps to mitigate the breach must be taken. 8. A patient’s lab test was left lying out on the counter of the staff workroom. Staff were in and out of the room all day. While this is not a security incident, it is a poor business practice. The risk is low as only staff trained in the use of PHI should have access to the information. 9. A patient’s radiology report was left lying out on the counter of the nursing unit. Patients and their family walked by this counter and also came to the counter to talk to staff. If seen, this would be a security breech.
References Amatayakul (2005) LaTour and Eichenwald-Maki McWay Roach Sayles
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Section 4 Healthcare Privacy, Confidentiality, Legal, and Ethical Issues 243
CASE 4-8 Investigation of Breach of Privacy
Questions and Suggested Answers 1. What actions should be taken? The facility should follow policy, which would probably define disciplinary action which could include termination. 2. What could have been done to prevent this situation from happening? The obvious best answer would be either to have not brought her child to work or to have brought her something to do, such as homework, a book, or other activity. The child could have been left in the lobby or other public area. If the child was to be in the HIM area, Margaret should have ensured that all systems were logged out before allowing her daughter to use the computer. The system should have had an automatic log-off, so that it would not have been active to allow the child access to patient information.
References Amatayakul (2002) Sayles
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Section 4 Healthcare Privacy, Confidentiality, Legal, and Ethical Issues 244
CASE 4-9 Privacy Violation by Former Employee
Questions and Suggested Answers 1. How would you investigate if this was a paper record? The investigation would include checking the chart location system to determine if the former sister-in-law had access to the chart and whether or not she was in a position to get access to the information where she worked. Unless someone saw her with the chart or it was found in her possession, there is no hard-and-fast way to determine for sure that she had access to the record if the chart location system did not indicate it was checked out to her. 2. How would you investigate, if this was an electronic health record? The audit trail would indicate if she looked up the information. 3. If you found evidence that the ex-sister-in-law did violate the privacy of the patient, what would you do? If there is documentation that the ex-sister-in-law violated the privacy of the patient, the facility would have to follow their policy. The former sister-in-law would probably be terminated, but again this decision must be based on the facility’s policy. The patient would have to be informed that appropriate steps have been taken. Mitigation of the breach would have to be addressed. 4. If you found no evidence of any wrongdoings, what would you do? If you have conducted an investigation and there is no evidence showing that the patient’s privacy was breached, you would notify the patient that there is no evidence to support her allegations.
References Amatayakul (2005) LaTour and Eichenwald-Maki Roach
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Section 4 Healthcare Privacy, Confidentiality, Legal, and Ethical Issues 245
CASE 4-10 Privacy and Security Training for New Staff
Questions and Suggested Answers 1. Is the content appropriate for HIM Department new employee training? Justify your response. The training outlined is not appropriate for all members of the HIM Department. All employees need to know basic principles such as logging out of the system, not sharing passwords, and to whom and when to report violations. But every member of the HIM staff may not need to know the distribution of transcribed documents. The training should be specialized for the needs of the various roles in the department. 2. Is this plan compliant with privacy regulations? No. 3. How can this plan be improved? • It should address ongoing training—not just upon hire. Ongoing training could include fliers, screen savers, tent cards, literature, and newsletters, as well as the traditional classes. •
The required documentation is not addressed. The documentation should include sign-in sheets, training materials, confidentiality statements, and database of training conducted.
•
The plan does not address that the needs of the HIM staff are different. o There should be some basic content that everyone needs and then break out the training so that the appropriate training for that position is conducted. o The assistant director would be appropriate for the general training that all HIM staff would be involved in but may not be the best person for the various positions in the department. o The supervisors might be in a better position for the detailed training required by transcription, release of information, research, archives, and other HIM staff positions.
References Amatayakul and Johns (2002) Hartley Hjort LaTour and Eichenwald-Maki Roach Sayles © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 4 Healthcare Privacy, Confidentiality, Legal, and Ethical Issues 246
CASE 4-11 Release of Information (ROI), Staff Privacy, and Privacy Rule Training Test
Questions and Suggested Answers Create an answer key for each of the questions presented in the new employee quiz shown in Figure 4-3 and give an explanation for your decision about what was the correct answer.
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Section 4 Healthcare Privacy, Confidentiality, Legal, and Ethical Issues 247
Figure 4-3 Release of Information (ROI) Staff Privacy and Health Insurance Portability and Acccountability Act (HIPAA) Training Quiz
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Section 4 Healthcare Privacy, Confidentiality, Legal, and Ethical Issues 248
References Amatayakul and Johns (2002) Hartley Hjort LaTour and Eichenwald-Maki Roach Sayles
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Section 4 Healthcare Privacy, Confidentiality, Legal, and Ethical Issues 249
CASE 4-12 Compliance with Privacy Training
Questions and Suggested Answers 1. What needs to be done from a legal standpoint to meet privacy rules requirements and best practices in privacy training? The facility needs to take steps to get in compliance with privacy rules. 2. What needs to be done from a training plan and management standpoint? They need to come up with an ongoing training plan that would include a strategy for the following: •
Covering training content
•
Meeting training documentation requirements
•
Ensuring that the entire workforce is included
•
Ensuring retention of training documentation is maintained
•
Identifying trainers
•
Customizing training for the various classifications of the workforce as appropriate
References Amatayakul and Johns (2002) Hartley Hjort Roach Sayles
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Section 4 Healthcare Privacy, Confidentiality, Legal, and Ethical Issues 250
CASE 4-13 Privacy Plan Gap Analysis
Questions and Suggested Answers 1. What would your response be if you were the admissions clerk? The Notice of Privacy Practices is a document that outlines how we will use your health information. 2. What would you do if you were the CPO? Additional training needs to be done. Then document the training and follow-up with the employees to ensure that they understand the information given and know how to handle the situation.
References Callahan-Dennis Hartley LaTour and Eichenwald-Maki Sayles
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Section 4 Healthcare Privacy, Confidentiality, Legal, and Ethical Issues 251
CASE 4-14 Security Measures for Access to Protected Health Information
Questions and Suggested Answers 1. What legal issues are involved in this situation? Terry’s access to the information system(s) was not removed when he was terminated. The covered entity is responsible for the protection of data as well as workforce security. There should be a process in place to terminate an employee’s PHI access upon termination of his or her employment with the covered entity. The facility will also have to mitigate negative impact of the security breach and conduct an investigation of the breach. 2. What steps would this facility need to take during its investigation? They would need to check the appropriate policies, check the audit trail, remove Terry’s access, and contact the domain owner to have the PHI removed. Also, once proof is obtained that the information was posted on Terry’s website, then the appropriate authorities would need to be notified. 3. What happens after you complete the investigation? It would need to be reported to OIG.
References Amatayakul (2005) Hartley LaTour and Eichenwald-Maki
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Section 4 Healthcare Privacy, Confidentiality, Legal, and Ethical Issues 252
CASE 4-15 Breach Notification
Questions and Suggested Answers 1. What privacy and security violations have occurred? The computer should not contain PHI but if it does, it should be encrypted. Also, it should not have been left in the car. 2. What should the facility do now? As it exceeds 500 patients, it needs to be reported to the Secretary of the Department of Health and Human Services. Also, they need to notify patients and determine the method of mitigation. 3. Who should be notified of the breach? Secretary of the Department of Health and Human Services as well as the patients involved. The news media should also be notified. 4. What method(s) of notification should be used? There is an online reporting mechanism for the Secretary. Patients should be notified by mail if an accurate address is available. The news media should help spread the word as well.
Reference Department and Health and Human Services
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Section 4 Healthcare Privacy, Confidentiality, Legal, and Ethical Issues 253
CASE 4-16 Breach of Information at Business Associate
Questions and Suggested Answers 1. What privacy and security violations have occurred? The business associate has the responsibility of notifying you of the breach. 2. What should Coding Consulting have done? Notify the healthcare facility so that appropriate steps can be taken. 3. What should your facility do now? Follow their policy regarding breaches which would include notifying patients, notifying DHHS as appropriate, notify media if the number of patients exceeds 500 patients, and mitigate problems. Depending on policy and contract, the facility may cancel the contract with the business associate.
Reference Department of Health and Human Services
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Section 4 Healthcare Privacy, Confidentiality, Legal, and Ethical Issues 254
CASE 4-17 Access to Health Information for Treatment
Questions and Suggested Answers 1. What options does the hospital have? The hospital can either open up all PHI to all nursing staff or just to all nursing staff on the unit. The hospital should also monitor access to the PHI to ensure there are legitimate reasons to access the information. There could also be emergency access measures that would enable employees who normally do not have access to PHI to gain it in an emergency situation. An investigation of each incident would be required. 2. What would you recommend? Justify your recommendation. Hospitals must take the approach that nothing should interfere with patient care. The following are situations when all clinicians should have access to PHI: •
In an emergency situation
•
When a patient codes, extra help is needed
•
When a unit is short-staffed and the facility floats nurses between units
References Abdelhak et al. LaTour and Eichenwald-Maki Roach Sayles
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Section 4 Healthcare Privacy, Confidentiality, Legal, and Ethical Issues 255
CASE 4-18 Monitoring Regulations Affecting Healthcare (Federal Register)
Questions and Suggested Answers The answer to this case study would be based on the regulation reviewed. Most of the information comes straight out of the Federal Register. The student will need to utilize critical thinking in discussing the changes that the regulation would make. Examples could include new databases, new policies, additional training, and the like. The comments on the proposed regulation should address pros and/or cons of the proposal. 1. Identify a proposed regulation that is related to healthcare. Provide your instructor with a copy of the regulation or an Internet link to this proposed regulation along with the following information on that proposed regulation. •
Name of regulation
•
Regulation number
•
What agency has submitted this regulation?
•
Summary of regulation
•
How does your proposed regulation apply to HIM?
•
What changes would this regulation cause in healthcare and HIM?
•
What comments would you submit to the agency proposing the regulation?
•
What deadline is there for submitting comments?
2. If you were to write a letter of comments back to the agency who submitted this regulation, what points would you want to make.
Reference Federal Register
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Section 4 Healthcare Privacy, Confidentiality, Legal, and Ethical Issues 256
CASE 4-19 Monitoring Legislation Affecting Healthcare (THOMAS)
Questions and Suggested Answers Identify a current piece of healthcare legislation in Congress. Provide the following information on the bill: 1. Name of the bill 2. Number of the bill 3. What is the current status of the bill? 4. Give an overview of the bill 5. Who proposed the bill? 6. How does it apply to HIM? The students’ responses to this case study will be based on the regulations reviewed. The status of the bill will be what has been done so far toward the passage of the bill. This could describe what House or committee actions had been taken. The information will come straight from THOMAS database.
Reference THOMAS, Library of Congress
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Section 4 Healthcare Privacy, Confidentiality, Legal, and Ethical Issues 257
CASE 4-20 Responsibilities in Release of Information (ROI)
Questions and Suggested Answers 1. Why would Margaret be concerned? Susan is not a physician, so she is not qualified to answer the patient’s questions. It is the physician’s responsibility to explain her condition, the care provided, and the appropriate treatment and outcome for a patient. The HIM professional’s job is to ensure the storage, access, data quality, and data analysis of the information. Although the HIM role does include patient advocacy, this role should not infringe on the physician’s role as the care provider. 2. How would you have handled this situation? Justify your position? The response should be to speak to Susan privately before she did any more damage. Margaret should be brief, giving details on why Susan should not be explaining the record to the patient, why the patient should be referred to the physician for information, and so on. Margaret would also ask Susan to come to her office when finished so that they could discuss this further. If Susan should have known better than to discuss this information with the patient, then she should be disciplined. If she was a new employee who may not know better, then she needs to be educated. If she is new, Margaret should be questioned as to why Susan was put in this position without proper training.
References Liebler and McConnell Sayles
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Section 4 Healthcare Privacy, Confidentiality, Legal, and Ethical Issues 258
CASE 4-21 Release of Information and the “Legal Health Record”
Questions and Suggested Answers 1. What is the legal record for this patient? All PHI, including that obtained from other facilities. It would include paper, microfilm, images, videos, and electronic documentation. 2. How should the facility respond to the “any and all” statement? The requester should be contacted and asked for specific guidance. Because the patient has been coming to the facility for so long, there could be quite a stack of records; depending on the number of patient encounters and length of care, the number of pages, microfilm pages, and digital pages of information you have retained for this patient could be quite large. If the requester insists on all information in the record, give the person a quote for the cost of all documentation. This may encourage the requester to ask for more specific information in his or her request for patient information from the records.
References AHIMA e-HIM Work Group on Maintaining the Legal EHR (2005) Roach
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Section 4 Healthcare Privacy, Confidentiality, Legal, and Ethical Issues 259
CASE 4-22 Authorization for Release of Information (ROI)
Questions and Suggested Answers Review the 9 authorizations shown in Figures 4-4 through 4-12 (in the Case Study Book). Determine if they are HIPAA compliant. If they are not HIPAA compliant, identify any deficiencies. Authorization 1:
Invalid because it is missing the purpose of the request.
Authorization 2: Invalid because there is not a date signed and the redisclosure statement is missing. Authorization 3: Invalid because there is not enough information to identify the physician to whom the information is being released. Authorization 4:
Invalid because it does not say what is to be released.
Authorization 5:
Invalid because it is missing the purpose.
Authorization 6: Invalid because the patient is an adult child, so the parent cannot sign. It is also missing the statement regarding inability of facility to condition treatment on the patient’s decision on whether or not to sign this. There is no purpose given for the release or the required redisclosure statement. Authorization 7: Invalid because the request is for prenatal records of the requester’s child. The mother is not the appropriate person to sign this form because the content is pregnancy related. This is missing many required elements, including not enough information given to identify to whom to send the records (no address, for example), no purpose, no statement about the inability of the facility to condition treatment, no redisclosure statement, and no date of signature. Authorization 8: Invalid because the request does not have a purpose, a revocation statement, an expiration date, or the notice about redisclosure. It also does not have the statement that the facility cannot condition treatment on the patient’s decision of whether or not to sign the form and the date the form is signed. Authorization 9: purpose.
Invalid because there is not a date signed, revocation statement, or
References LaTour and Eichenwald-Maki Roach Sayles © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 4 Healthcare Privacy, Confidentiality, Legal, and Ethical Issues 260
CASE 4-23 Processing a Request for Release of Information (ROI)
Questions and Suggested Answers 1. A patient just called. The patient has an appointment at her doctor’s office in 1 hour and wants copies of records to take to the office. The hospital has a policy that requires a 48-hour notice, except in medical emergencies. The patient did not specify what records she needs. Following the policy is critical but so is customer service. The ROI coordinator should probably provide the copies of records, but should also educate the patient on what he or she needs to do in the future. The ROI coordinator needs to know what should be released. There are 3 possibilities: •
Contact patient to find out what is needed.
•
Contact physician’s office to determine what is needed.
•
Follow policy on what to release in this situation.
The policy and procedures should specify which of the 3 steps should be taken. 2. A patient has requested that his charts be sent to Disability Determination 3 times and that department has not received them. Your records show that they have been sent twice. The patient is very upset. To provide good customer service, the ROI coordinator should verify the address and contact name with the Disability Determination Office and resend the information. Other appropriate options are faxing the request or having the patient pick up the information to deliver it to Disability Determination Office. 3. An FBI agent shows up and flashes a badge at you. He demands that you release a patient’s chart to him immediately. You need more information. In most cases, the FBI would need patient consent, a subpoena, or a court order. There are instances such as national security where the FBI could get access to records. 4. Dr. Lawrence calls and requests a copy of the medical record on Stephanie Smith. The records show that Dr. Jones was the patient’s physician. Dr. Jones and Dr. Lawrence are not partners. If the patient is now a patient of Dr. Lawrence’s, the ROI coordinator should follow facility policy. HIPAA would allow release for TPO, but some facilities/states require stricter controls, thus requiring patient consent. 5. You receive a subpoena requesting your presence in court. You do not want to appear, so you talk to the court clerk. The subpoena specifies all charts for the period of June 2004 to September 2011. The hospital has records for the period of April 1975 to the present. Because they are essentially asking for any and all records for a specific period, you would need to contact the court to determine what records are specifically needed. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 4 Healthcare Privacy, Confidentiality, Legal, and Ethical Issues 261
6. You receive a subpoena requesting the entire medical record for the 3/2/12 admission of Mary Taylor. When the record is pulled and reviewed, you realized that she has a history of substance abuse documented in this admission. You would need to require a court order or patient consent to release this information because this is a substance abuse record. 7. You receive a subpoena to appear in court and to bring a specific medical record. You are scheduled to testify tomorrow. How will you prepare? What guidelines will you follow in testifying? You would need to review the medical record so that you are familiar with its content. You would need to dress professionally and to act professionally on the witness stand. When possible you should answer “yes” or “no” and should never expand on the question but rather be as succinct as possible. You should not get upset if the attorney gets heated in the questioning. Also, you cannot interpret the information in the chart—you can only read it and answer questions about how the information is collected, processed, and maintained. 8. You receive a subpoena for Mary Taylor’s medical record. When the record is pulled and reviewed, you realized that she is HIV positive. These records, as with any PHI, are subject to HIPAA. Any further restrictions would need to be addressed based on state law, because there is no federal law that restricts this information over any other PHI. State laws may be more stringent than HIPAA, so they should be checked for your state. 9. Today, a patient requested a copy of all of his records to take to his attorney. Your policy prohibits records from being released without a 24-hour notice, except for patient care. You explain the situation and the patient becomes extremely hostile. You would probably release the information even with the policy because you want to be customer friendly, but you would also want to educate the patient for any further requests. If the patient gets too irate, then you may need to get management involved and potentially security as well. 10. A mother requested a discharge summary of her daughter's record (6/6/12 discharge). The daughter’s record shows that she delivered a baby during this admission. This information cannot be released because it is pregnancy related. 11. Dr. Smith requests his wife’s medical record. He cannot get the information without his wife’s consent.
References Abdelhak et al. LaTour and Eichenwald-Maki Roach Sayles
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 4 Healthcare Privacy, Confidentiality, Legal, and Ethical Issues 262
CASE 4-24 Reporting Communicable Diseases
Questions and Suggested Answers 1. Which of the cases in Table 4-2 would you list for your state? 2. If the disease is reportable, how soon after diagnosis should it be reported? The answers depend on the state reporting laws. The example provided in Table 4-2 provides the reportable diseases for Georgia.
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 4 Healthcare Privacy, Confidentiality, Legal, and Ethical Issues 263
Table 4-2 Reportable Diseases Reportable Diseases Disease Yes/Reporting Deadline Herpes zoster Cholera Hantavirus pulmonary syndrome Immediately Varicella Hepatitis A Immediately AIDS 7 days Cancer 7 days Gonorrhea 7 days Tetanus 7 days Rubella 7 days Malaria 7 days Poliomyelitis Immediately Whooping cough Immediately Diphtheria Immediately Mononucleosis Coxackie Pneumococcal septicemia Spirillum fever Whipple disease Influenza Streptococcus pneumoniae 7 days Shingles Legionnaires disease 7 days Bacterial meningitis Immediately Lyme disease 7 days
No X X X
X X X X X X X
© 2014 Cengage Learning ®. All Rights Reserved.
References Abdelhak et al. Georgia State Health Department Pozgar Roach © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 4 Healthcare Privacy, Confidentiality, Legal, and Ethical Issues 264
CASE 4-25 Disclosure of Information from a Psychiatric Record
Questions and Suggested Answers What legal principles apply in this situation? The legal concept is failure to warn. The psychiatrist has a duty to protect the ex-wife of his patient. He could be legally liable because he did not take action to protect her from his patient who made a definite threat toward her. Failure to warn is a liability issue for the physician. Protection of others is an exemption to the strict privacy laws for psychiatric records.
References Pozgar Roach
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 4 Healthcare Privacy, Confidentiality, Legal, and Ethical Issues 265
CASE 4-26 Processing a Request for Information from an Attorney
Questions and Suggested Answers You have just processed an attorney request for copies of records. There were 634 pages copied. Use the information in Table 4-3 and the additional notes to complete the invoice for this service (excluding postage). Table 4-3 Invoice for Retrieval Fees for Copies to Attorney Invoice for Retrieval Fees for Copies to Attorney Service
Charge (see notes below)
Quantity
Charges
Retrieval fee
$20.00
1
$20.00
Per page
$0.75 $0.65 $0.50
25 50 559
$18.75 $37.50 $279.50
Microfilm per page
$1.00
0
$0.00
Certification fee
$7.50
0
$0.00
1–25 pages 26–75 pages >75 pages
Total charges (excluding postage)
$355.75
© 2014 Cengage Learning ®. All Rights Reserved.
References American Health Information Management Association (AHIMA) (n.d. 1) Law Offices of Thomas J. Lamb, P.A.
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Section 4 Healthcare Privacy, Confidentiality, Legal, and Ethical Issues 266
CASE 4-27 Processing a Request for Health Information from a Patient
Questions and Suggested Answers You have just processed a patient request for information. There were 43 pages of hard copy and 39 pages of microfilm. Use the information in Table 4-4 and the additional notes and complete the invoice (excluding postage). Table 4-4 Invoice for Retrieval Fees for Copies to Patient Invoice for Retrieval Fees for Copies to Patient Service
Charge (See notes below)
Quantity
Charges
Retrieval fee
$20.00
0
$0.00
Per page
$0.75 $0.65 $0.50
25 8 0
$18.75 $5.20 $0.00
Microfilm per page
$1.00
0
$0.00
Certification fee
$7.50
0
$0.00
1–25 pages 26–75 pages >75 pages
Total charges (excluding postage)
$23.95
Please note that the number of pages only equals 33 because the first 10 pages are free. Also, for release to the patient there is no retrieval fee. © 2014 Cengage Learning ®. All Rights Reserved.
References American Health Information Management Association (AHIMA) (n.d. 1) Law Offices of Thomas J. Lamb, P.A.
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 4 Healthcare Privacy, Confidentiality, Legal, and Ethical Issues 267
CASE 4-28 Processing a Request for Certified Copy of Health Information
Questions and Suggested Answers You have just processed a request for information from a subpoena. There were 423 pages of hard copy, 345 pages of microfilm copies. The authorization requests that records be certified. Use the information in Table 4-5 and complete the invoice (excluding postage). Table 4-5 Invoice for Retrieval Fees for Certified Copies Invoice for Retrieval Fees for Certified Copies Service
Charge (See notes below)
Quantity
Charges
Retrieval fee
$20.00
1
$0.00
Per page
$0.75 $0.65 $0.50
25 50 348
$18.75 $37.50 $174.00
Microfilm per page
$1.00
345
$345.00
Certification fee
$7.50
1
$7.50
1–25 pages 26–75 pages >75 pages
Total charges (excluding postage)
$582.75
© 2014 Cengage Learning ®. All Rights Reserved.
References American Health Information Management Association (AHIMA) (n.d. 1) Law Offices of Thomas J. Lamb, P.A.
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 4 Healthcare Privacy, Confidentiality, Legal, and Ethical Issues 268
CASE 4-29 Processing a Request for Health Information for Worker’s Compensation
Questions and Suggested Answers You have just processed a worker’s compensation request for information. There were 179 pages of hard copy. Use the information in Table 4-6 and the additional notes to complete the invoice (excluding postage). Table 4-6 Invoice for Retrieval Fees for Worker’s Compensation Request Invoice for Retrieval Fees for Worker’s Compensation Request Service
Charge (see notes below)
Quantity
Charges
Retrieval fee
$20.00
0
$0.00
Per page
$0.75 $0.65 $0.50
25 50 104
$18.75 $37.50 $52.00
Microfilm per page
$1.00
0
$0.00
Certification fee
$7.50
0
$0.00
1–25 pages 26–75 pages >75 pages
Total charges (excluding postage)
$108.25
© 2014 Cengage Learning ®. All Rights Reserved.
References American Health Information Management Association (AHIMA) (n.d. 1). Law Offices of Thomas J. Lamb, P.A.
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Section 4 Healthcare Privacy, Confidentiality, Legal, and Ethical Issues 269
CASE 4-30 Valid Authorization for Requests for Release of Information (ROI)
Questions and Suggested Answers Who should sign the information requests? Table 4-7 shows a summary of release of information requests that were received today and who should sign the authorization. The age of majority in this state is 18. Table 4-7 Information Requests Information Requests Description of Patient
Who Should Sign Authorization and Why?
17-year-old with laceration
Parent, because patient is underage.
14-year-old with gonorrhea
Patient, because of sexual content of material.
26-year-old mentally retarded male
Most likely it would be the patient’s legal guardian, but you will need documentation to support any claim.
43-year-old surgery patient
Patient.
83-year-old surgery patient
Patient, unless there is documentation to say otherwise.
63-year-old Alzheimer’s patient
There should be a guardian appointed who would sign the consent. There should be documentation to support this.
© 2014 Cengage Learning ®. All Rights Reserved.
References Abdelhak et al. Davis and LaCour McWay Pozgar Roach Yaggie © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 4 Healthcare Privacy, Confidentiality, Legal, and Ethical Issues 270
CASE 4-31 Health Information Management (HIM) Department Process for Subpoenas for Release of Information (ROI)
Questions and Suggested Answers How should the director handle this? Include quality improvement, training, and other issues, as appropriate. The director should immediately meet with the release of information staff. She should tell them about the call and give them directions that will begin immediately. •
The director would need to identify any outstanding subpoenas and make sure they are processed timely.
•
Determine the problem and improve the process so that even after this crisis is resolved, it will not happen again. The director would also need to come up with a process to make sure that the subpoenas arrive at the courthouse in plenty of time and that the information provided is exactly what is requested. Either the director or assistant director would need to monitor this initially because of the existing problems.
•
Additional training may be required to make sure the ROI staff know how to process the subpoenas and that they know the importance of compliance with the deadlines. The staff also needs to know what contempt of court is.
•
The staff would need to be told explicitly what the director’s expectations are for turnaround, monitoring, and quality. Either the director or assistant director would need to monitor the quality of the work being submitted.
•
The director should also notify administration and risk management.
Reference Pozgar
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Section 4 Healthcare Privacy, Confidentiality, Legal, and Ethical Issues 271
CASE 4-32 Validate Subpoenas for Release of Information (ROI)
Questions and Suggested Answers Determine if the subpoenas in Figures 4-13 through 4-16 are valid and identify any deficiencies. Subpoena 1:
Although this subpoena is technically valid, the release of information clerk should investigate to determine what information is truly needed. The “any and all” statement is too broad.
Subpoena 2:
Invalid because it does not have the docket number. The “any and all” statement is too broad. The requester should be contacted to determine what information is truly needed.
Subpoena 3:
Invalid because it does not have the name of the parties involved in the lawsuit. The “any and all” statement is too broad. The requester should be contacted to determine what information is truly needed.
Subpoena 4:
Although this subpoena is technically valid, the release of information clerk should investigate to determine what information is truly needed. The “any and all” statement is too broad.
References Abdelhak et al. McWay Roach
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Section 4 Healthcare Privacy, Confidentiality, Legal, and Ethical Issues 272
CASE 4-33 Quality and Performance Improvement in Release of Information (ROI) Turnaround Time
Questions and Suggested Answers 1. What are the benefits and disadvantages of each option? •
Hire a consultant to come in and clean it up: o Advantage: You can have a more people work on the backlog at one time and get it caught up quickly. o Disadvantage: There is no guarantee that you can keep control of the backlog in the long term because you have not addressed why you got behind in the first place. You will still have the same staff that probably caused or at least contributed to the problem in the first place. There could be other reasons that caused or at least contributed to the backlog, such as vacancies and computers or copy machines being out of commission.
•
Clean it up yourself: o Advantage: Your staff know your process and can start cleaning up the backlog. o Disadvantage: It would require overtime or additional staff, and the current staff are the ones who let the problem build up.
•
Outsource the services to a copy service: o Advantage: If the staff is the problem, you get a whole new staff to start fresh. Also, it frees you up to work on other issues/projects such as the electronic health record. o Disadvantage: This will take time to get started with the cleanup because of issuing a request for proposal, checking references, and negotiating the contract. A copy service would require you to give up the revenue from the release of information function. Outsourcing release of information also requires you to give up some of your control of the entire function.
2. What facts would you want to have available in order to make your decision? The student should want to know the expected costs of each option and what caused the problem in the first place. If it were a staff issue, it would support outsourcing the release of information function. If there were other problems such as vacant positions, broken copy machines, downtime on computer system, staff out on maternity leave, and the like, then that would be an important factor in the decision-making process. These other problems would support cleaning it up yourself or hiring a consultant on a temporary basis to solve the backlog.
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Section 4 Healthcare Privacy, Confidentiality, Legal, and Ethical Issues 273
3. Which option would you choose? Justify your decision. Students could choose and justify any of the 3 options. •
If it is to hire a consultant, they can justify it by saying that the staff wanted to get it knocked out quickly by increasing the resources and then get back to the normal routine— assuming that the normal routine was not the problem.
•
If the students choose to clean it up in-house, they could justify it by the staff being able to start immediately and knowing the routine.
•
The copy service could be justified by indicating that the staff wanted to focus on other areas in the department and did not want to risk having the problems reappear.
References Abdelhak et al. LaTour and Eichenwald-Maki
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Section 4 Healthcare Privacy, Confidentiality, Legal, and Ethical Issues 274
CASE 4-34 Updating the Retention and Destruction Policy for Healthcare Records
Questions and Suggested Answers 1. What should the minimum retention policy be based on? Needs of users (including researchers), state law, advice of attorney, AHIMA recommended standards, Medicare’s Conditions of Participation, and Medicaid’s requirements. 2. What are your options? You can expand your storage space on-site, use off-site storage, shred records or microfilm, or scan records or burn them. 3. Which option would you recommend? Justify your response. The students can choose any of the options. Justification can be based on cost, staffing levels, needs of users, and accessibility.
References Davis and LaCour LaTour and Eichenwald-Maki McWay Roach Sayles
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Section 4 Healthcare Privacy, Confidentiality, Legal, and Ethical Issues 275
CASE 4-35 Evaluating Records for Destruction
Questions and Suggested Answers Assume that today’s date is June 2, 2013. Which of the records in Table 4-8 should be destroyed? Table 4-8 Retention Decisions Retention Decisions Record Number
Dates of Service
Retention Decision (Yes/No)
123456
12/6/11 4/16/05 4/16/06
No
145321
1/14/07 3/6/00
Yes
237621
7/6/02
No
9/1/01 179341
2/25/09 7/16/09
Yes
180072
10/19/04
Yes
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References Abdelhak et al. Davis and LaCour LaTour and Eichenwald-Maki McWay Roach Sayles © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 4 Healthcare Privacy, Confidentiality, Legal, and Ethical Issues 276
CASE 4-36 Developing a Documentation Destruction Plan
Questions and Suggested Answers 1. Critique the above plan. Students’ comments may vary and create opportunity to discuss options with the class. 2. Rewrite the plan so that it complies with federal laws (including privacy regulations), your state laws, and recommended HIM practices. In your plan, correct any errors and make the necessary changes so that the plan meets the needs of not only the HIM Department, but also the entire enterprise. •
MPI data should be retained permanently
•
The number of years that the medical record should be retained is only 5 years. While state laws vary, AHIMA recommends 10 years and the Medicare Conditions of Participation is 5 years.
•
Indices and registers should be retained permanently.
•
Incinerating records by fire is acceptable but there may be a problem transferring records, so you may want to specify that you use the hospital incinerator. A more common method of destruction is shredding.
References Abdelhak et al. Davis and LaCour LaTour and Eichenwald-Maki McWay Roach
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 4 Healthcare Privacy, Confidentiality, Legal, and Ethical Issues 277
CASE 4-37 Research Studies and Ethics
Questions and Suggested Answers 1. What should you do? You should meet with the physician and tell him what you have discovered. The meeting should not be confrontational because there could be something that you did not know that may have caused these particular persons to be removed from the study legitimately. 2. What issues are involved in this situation? This is an ethical issue where it appears that data have been manipulated to alter the results of the study. If manipulation of data alters the results of the study, it could result in falsifying grant reports, inaccuracies in findings reported in research journals, and other issues related to the research study.
References Harman LaTour and Eichenwald-Maki
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Section 4 Healthcare Privacy, Confidentiality, Legal, and Ethical Issues 278
CASE 4-38 Identity Theft
Questions and Suggested Answers 1. What should Sandra do? This is an ethical and a legal issue. She should report the patient identity swap because this is fraud. Covering for the patient would have her guilty of covering up an unethical and illegal event. She should notify her supervisor, administrator, or other appropriate person. What legal and ethical issues are involved? (Additional question for class discussion.) A number of issues are identified in the case study, including fraud, identity theft, and inaccurate healthcare records. Having inaccurate records may cause problems with future patient care for the real patient, Bob. For example, if his brother has an appendectomy on this visit and at a later date, Bob presents with symptoms of appendicitis, the doctors may not realize Bob has appendicitis before the appendix ruptures because the record would show that the patient had already had his appendix out. In addition, there would be problems with the insurance appropriately not wanting to pay for two appendectomies.
References Harmon LaTour and Eichenwald-Maki McWay
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Section 4 Healthcare Privacy, Confidentiality, Legal, and Ethical Issues 279
CASE 4-39 American Health Information Management Association (AHIMA) Code of Ethics
Questions and Suggested Answers 1. Document how you as an HIM professional can comply with each standard. For each standard, you should document how you as an HIM professional can comply with the AHIMA Code of Ethics. 2. Why is a code of ethics important? It is a guide to a profession about the behaviors that are acceptable from its professionals. It also gives the public principles to which they can hold the HIM professional. 3. What does the AHIMA Code of Ethics mean to you and your career? The students have flexibility here. They can talk about how ethical behavior protects the hospital from compliance issues or privacy violation. They can talk about how it protects HIM professionals from violating patient privacy or doing something else that would get them terminated from their job.
References American Health Information Management Association (AHIMA) (2011) McWay Sayles
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Section 4 Healthcare Privacy, Confidentiality, Legal, and Ethical Issues 280
References Abdelhak, M., Grostick, S., Hanken, M. A., & Jacobs, E. (Eds.). (2007). Health information: Management of a strategic resource (3rd ed.). Philadelphia: W.B. Saunders. AHIMA e-HIM Work Group on Maintaining the Legal EHR. (2005). Update: Maintaining a legally sound health record—Paper and electronic. Journal of AHIMA, 76(10), 65A–L. Amatayakul, M. (2002). A reasonable approach to physical security. Journal of AHIMA, 73(4), 16A–C. Amatayakul, M. (2005). Reporting security incidents. Journal of AHIMA, 76(3), 60. Amatayakul, M., & Johns, M. (2002). Compliance in the crosshairs: Targeting your training. Journal of AHIMA, 73(10), 16A–F. American Health Information Management Association (AHIMA). (n.d. 1). Practice brief: Release of information reimbursement laws and regulations (updated). Retrieved January 15, 2013, from http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_023132.hcsp?dDocName =bok1_023132 American Health Information Management Association (AHIMA). (2011). AHIMA code of ethics. Retrieved January 15, 2013, from http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_024277.hcsp?dDocName =bok1_024277 Brodnik, M. S., McCain, M. C., Rinehart-Thompson, L. A., Reynolds, R. B. et al. (2009). Fundamentals of law for health informatics and information management. Chicago: American Health Information Management Association. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 4 Healthcare Privacy, Confidentiality, Legal, and Ethical Issues 281
Callahan-Dennis, J. (2001). Leading the privacy risk assessment. AHIMA convention proceedings. Retrieved January 15, 2013, from http://library.ahima.org/xpedio/groups/public/documents/ahima/bok2_001416.hcsp?dDocName =bok2_001416 Davis, N., & LaCour, M. (2007). Introduction to health information technology (2nd ed.). Philadelphia: W.B. Saunders. Department of Health and Human Services. (n.d.). Breach notification rule. Retrieved January 15, 2013, from http://www.hhs.gov/ocr/privacy/hipaa/administrative/breachnotificationrule/ Dougherty, M. (2001). Practice brief: Accounting and tracking disclosures of protected health information. Journal of AHIMA, 72(10), 72E–H. Federal Register. (n.d.). The Federal Register (FR): Main page. Retrieved from http://www.gpoaccess.gov/fr/ Georgia State Health Department. (n.d.). Georgia division of public health: Notifiable diseases. Retrieved January 15, 2013, from http://health.state.ga.us/epi/disease/report.asp Harman, L. B. (2006). Ethical challenges in the management of health information: Process and strategies for decision-making (2nd ed.). Sudbury, MA: Jones and Bartlett. Hartley, C. P. (2004). HIPAA plain and simple: A compliance plan for health care professionals. Chicago: American Medical Association. Hjort, B. (2003). Practice brief: HIPAA privacy and security training (Updated). Retrieved January 15, 2013, from http://library.ahima.org/xpedio/idcplg?IdcService=GET_HIGHLIGHT_INFO&QueryText=%2 8HIPAA+privacy+and+security+training%29%3cand%3e%28xPublishSite%3csubstring%3e% © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 4 Healthcare Privacy, Confidentiality, Legal, and Ethical Issues 282
60BoK%60%29&SortField=xPubDate&SortOrder=Desc&dDocName=bok1_048509&Highlig htType=HtmlHighlight&dWebExtension=hcsp Hughes, G. (2001). Practice brief: Patient access and amendment to health records. Journal of AHIMA, 7(5), 64S–V. Hughes, G. (2002). Practice brief: Notice of privacy practices (Updated). Retrieved January 15, 2013, from http://library.ahima.org/xpedio/idcplg; http://library.ahima.org/xpedio/idcplg?IdcService=GET_HIGHLIGHT_INFO&QueryText=%2 8Notice+of+Privacy+practices%29%3cand%3e%28xPublishSite%3csubstring%3e%60BoK%6 0%29&SortField=xPubDate&SortOrder=Desc&dDocName=bok1_048808&HighlightType=Ht mlHighlight&dWebExtension=hcsp LaTour, K., & Eichenwald-Maki, S. (2011). Health information management: Concepts, principles and practice (3rd ed.). Chicago: American Health Information Management Association. Law Offices of Thomas J. Lamb, P.A. (n.d.). Medical records copying charges by state. Retrieved January 15, 2013, from http://www.lamblawoffice.com/medical-records-copying-charges.html. Liebler, J. G., & McConnell, C. R. (2012). Management principles for health professionals (6th ed.). Sudbury, MA: Jones & Bartlett. McWay, D. C. (2010). Legal and ethical aspects of health information management (3rd ed.) Clifton Park, NY: Thomson Delmar Learning. Pozgar, G. D. (2012). Legal aspects of health care administration (11th ed.). Sudbury, MA: Jones & Bartlett.Roach, W. H. (2006). Medical records and the law (4th ed.). Sudbury, MA: Jones & Bartlett.
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Section 4 Healthcare Privacy, Confidentiality, Legal, and Ethical Issues 283
Sayles, N. (2013). Health information management technology: An applied approach (4th ed.). Chicago: American Health Information Management Association. Thieleman, W. (2002). A patient-friendly approach to the record amendment process. Journal of AHIMA, 73(5), 44–47. THOMAS, Library of Congress. Retrieved from http://thomas.loc.gov/home/thomas.html. Yaggie, E. (2001). Release of information: The basics. Journal of AHIMA, 72(5), 56–61.
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SECTION FIVE Information Technology and Systems
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Section 5 Information Technology and Systems 285
CASE 5-1 System Conversion
Your facility is getting a new master patient index (MPI). You are replacing an existing computerized MPI that no longer meets the needs of the organization. Most of the staff are excited about the new functionality that will be available. The problem you find is that there are some differences in the structure of the data fields between the 2 systems. Use Table 5-1 to review the differences between them. Determine if the data in the old system need to be converted to meet the character requirements in the data dictionary of the new system. If any of the fields need to be converted, specify exactly what needs to be done (add leading zeroes, delete characters, convert data to new valid entries, and so forth). Precision is important, since the programmers will be using this information to write the conversion software code. If appropriate, provide the programmers with examples so that there will not be any confusion.
Questions and Suggested Answers Document your findings in the comments column in Table 5-1. Table 5-1 Field Analysis for System Conversion Field Analysis for System Conversion Field
Old System
New System
Comments
Date of
mmddyyyy
mmddyyyy
No changes needed, since the format is
Birth
exactly the same.
(DOB) Last
25 characters
30 characters
Name First Name
No changes needed, since the change only increases the number of characters available.
20 characters
18 characters
Most likely this would not be a problem, but you may want to check the existing database
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Section 5 Information Technology and Systems 286
for patients’ names that have more than 18 characters in the first name field.
Middle
1 character
1 character
No changes needed.
Medical
Cardiology
There is no way to break medical down
Newborn
Cardiovascular
further into cardiology, pulmonary, or other
Surgery
services with just that information. If you
OB/Gyn Pediatrics
Dermatology
Surgery
Endocrinology
could possibly assume that the service
Family Practice
should have been cardiology and convert the
Initial Service
assume that if Dr. Smith is the attending
Gastroenterology
physician and he is a cardiologist, then you
data accordingly or you could leave the data as is and start fresh with the go-live date.
General Surgery
Users would need to be aware of this when
Gynecology
analyzing data (e.g., a patient’s service could
Internal Medicine
change from medical to cardiology if Dr. Smith,
Neonatology
the
attending
physician,
is
a
cardiologist).
Neurology Neurosurgery Newborn Obstetrics Oncology Orthopedics Pediatrics Pulmonary
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Section 5 Information Technology and Systems 287
Patient
Inpatient
Inpatient
This probably would be left as is unless you
Types
ER
Cardiac Rehab
are able to connect outpatient surgery and
Outpatient
ER
cardiac rehab to other information stored in
Physician
4 digit
the system, such as a charge or room
Outpatient
assignment (e.g., outpatient could change to
Surgery
cardiac rehabilitation if there is a charge for
Outpatient
cardiac rehabilitation).
5 digit
You would need to decide if new numbers
Number
would be assigned or if another method of conversion would be used, such as a leading zero. The programmers could easily convert the data to add the leading zero (e.g., the physician number could change from 1234 to 01234).
Medical
7 digit
10 digit
You would need to decide if new numbers
Record
would be assigned or if another method of
Number
conversion would be used, such as a leading zero. The programmers could easily convert the data (e.g., the medical record number could
change
from
1234567
to
0001234567). Social
11 characters
9 characters
Assume that the extra 2 characters were
Security
dashes that are no longer needed. The
Number
programmers can remove the dashes in the conversion.
City
20 characters
15 characters
Would need to confirm that 15 characters is an adequate number based on your database.
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Section 5 Information Technology and Systems 288
State
20 characters
2 characters
Would need to convert the full name of a state to the official 2-digit abbreviation.
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References Amatayakul Sayles and Trawick Wager et al.
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Section 5 Information Technology and Systems 289
CASE 5-2 Web Page Design
You are the information systems liaison for the Health Information Management (HIM) Department. You have been asked to design and develop the web page for the HIM Department. You are a Registered Health Information Administrator (RHIA) with information systems experience, but you are not an expert web page designer, so the pages will be simple. The HIM Department is constantly getting requests for the same information, so the HIM director decided that basic information about the department should be provided on the hospital website and/or intranet. This availability of basic information about the department should cut down on the phone calls received in the department and improve customer service as well. The director has told you to create 3 simple web pages for the HIM Department at Island Palms General Hospital. These pages should link together and include, at a minimum, the following content: •
Name of the hospital
•
Name of department
•
Hours of operation
•
Pictures of HIM Department and Director
•
Services provided by HIM Department
•
Phone numbers for services
•
HIM administration names and contact information
•
Information on how to request information
•
Location of department
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Section 5 Information Technology and Systems 290
•
Information for physicians (pulling charts, research, incomplete charts, etc.)
•
Other information, as appropriate
The director also specified that the web pages should utilize: •
Hyperlinks
•
Pictures
•
Tables
•
Background design
•
Color font to accentuate key content
•
Other tools as appropriate
The pages should all have the same look and feel, complementing each other in color, structure, and the like. They should not contain redundant information; however, the hospital and department name should be on each page as well as a link to the department home page and hospital home page. The director has asked that you make recommendations on whether these pages should be on the Internet or intranet.
Educator Suggestion: The results from the students will be individual and original. Class discussion would be beneficial for the students to review the variances in ideas for the web pages.
References Abdelhak et al. Sayles
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Section 5 Information Technology and Systems 291
CASE 5-3 Policy and Procedure Development
You have been given the responsibility to write a policy and procedure on how to abstract data into the quality indicator systems. The basic demographic information is already in the system due to an interface with the hospital information system, so the abstractors will only abstract clinical data. Use proper policy and procedure formatting. Write the policy as if the reader knew nothing about the system or the policies and procedures. Take into consideration what the user would want and need to know if using this system for the first time. Remember that policies and procedures should connect the technology and the manual processes. Assume that log-in instructions are spelled out in another policy and procedure.
Questions and Suggested Answers The students have a lot of flexibility here. In order to identify an appropriate policy and procedure and the steps involved in the process, the students could use experiences gained at clinical sites, experience from the HIM Department laboratory, or other knowledge acquired. The policy and procedure should give very specific instructions, such as which field(s) to enter, which field format to use, which buttons to push to save the data entered, and so on. The policy and procedure should include the following: •
Title
•
Policy
•
Name of the facility
•
Implementation date
•
Tasks
•
Responsible party
•
Policy number or other tracking measures
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Section 5 Information Technology and Systems 292
The content of the policy and procedure should provide step-by-step instructions such as the following: •
Which screens should be used
•
Which data elements should be completed
•
How to enter data into quality indicator system
•
How to run reports
References Abdelhak et al. LaTour and Eichenwald-Maki McWay Sayles
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Section 5 Information Technology and Systems 293
CASE 5-4 Database Design
You are an RHIA who works in the information systems department. You have extensive HIM experience as well as information systems experience. You tend to get projects related to HIM. Your next assignment is to create a data dictionary that will be used for data collection in the new MPI at your hospital. Your HIM background kicks in when you see the data quality issues in the instructions that you are provided. Administration has told you that the data elements collected in Table 5-2 will be used to manage data collection in your new computerized MPI. Each row indicates 1 field; the format column tells how the data should be formatted and the number field is the number of characters the field should allow.
Questions and Suggested Answers Analyze this information and identify possible problems with the way the fields would be entered into the system. Make recommendations on how to improve the information, including missing data elements, inappropriate data elements, ways to build quality into the system, ways to improve data collection, and so on. You have also been instructed to ensure that the data elements meet Uniform Hospital Discharge Data Set (UHDDS), Uniform Ambulatory Care Data Set (UACDS), and Data Elements for Emergency Department Systems (DEEDS) requirements.
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Section 5 Information Technology and Systems 294
Table 5-2 Field Properties Field Properties Field
Format
Number of Characters
Name
FN MI LN (alpha)
25
Address
Alpha
25
City, State, Zip
Alphanumeric
25
Discharge Date
Numeric
6
Admission Date
Numeric
6
Discharge Disposition
01, 02, 03, 04, 05, 06, 07, 20
2
Service
Alpha
3
Date of Birth
Numeric
6
Race
b, w, h
2
Gender
m, f, u
1
Ethnicity
Hispanic/Non-Hispanic
1
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Problems that the students may identify include the following: •
Name—This field should be broken down into 3 separate fields: Last Name, First Name, and Middle Initial or Middle Name. The number of characters for last name and first name should be about 25 each. The number of characters for the middle name would depend on whether you collected the whole name or the middle initial.
•
Street Address—You should allow alphanumeric data entry and may consider more characters than 25. You may want to add a second address field to capture long addresses.
•
City, State, ZIP—These data elements should be broken into 3 separate fields. City should have approximately 20 characters. State should be a drop-down box with all 50 states plus the District of Columbia and the U.S. territories. ZIP code should be numeric and allow either 5 or 9 characters.
•
Discharge Date—The date should be 8 characters to allow for mmddyyyy format entry.
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Section 5 Information Technology and Systems 295
•
Admission Date—The date should be 8 characters to allow for mmddyyyy format entry.
•
Disposition—The list is too short because it does not include all possible dispositions. Students should report all of the valid discharge dispositions as shown in the UHDDS.
•
Date of Birth—The date of birth should be 8 characters to allow for mmddyyyy format entry.
•
Race—The form allows 2 characters entry when 1 is all that is required. A drop-down box should be used.
•
Ethnicity—The ethnicity item should include all of the option for the UHDDS. A dropdown box should be used.
•
Some possible missing data fields are Home Phone, Work Phone, Cellular Phone, Alias, and Previous Name.
References Abdelhak et al. Amatayakul Johns LaTour and Eichenwald-Maki McWay Sayles
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Section 5 Information Technology and Systems 296
CASE 5-5 Database Development
You are an HIM subject-matter expert for a vendor who has just entered the Ambulatory EHR business arena. You have been assigned the responsibility of developing data entry screens for the programmer to use in the development of the system. Your instructions are to use Microsoft Access to develop 3 data entry computer screens for an EHR. You must use sound user interface principles. Each form should use different types of data entry skills and should build in data quality principles. In other words, you need to use different types of entry, such as free text, radio buttons, check boxes, drop-down boxes, and the like. Because all of the screens will be part of the same EHR, they need to use the same colors, have the same look and feel, and so on. Each screen should contain at least 8 data elements. All screens should have at least 1 drop-down box with data populated.
Questions and Suggested Answers Write narratives to describe each of the 3 screens that you developed. In each narrative, answer the following questions: In answering the questions, the student has an opportunity to display creativity, but should also demonstrate knowledge of when the various field types are appropriate. Examples of appropriate uses are as follows: •
Free text: progress note.
•
Radio buttons: to select if patient wants to be in or opt out of directory.
•
Check box: could be used to document that patient has signed advanced directive.
•
Drop-down boxes: could be used to select state. This would be a good drop-down box to populate as required by the case study. The student could easily populate the 50 states, the District of Columbia, and U.S. territories.
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Section 5 Information Technology and Systems 297
1. What is the purpose of the screen? The purpose of the screen will vary with the type of form that the student selects. Examples include the following: •
To document the immediate postoperative surgical note.
•
To complete history and physical examination.
•
To create medication list.
•
To update the problem list.
2. Why is each data element important to this screen? This is a justification of why you selected the various data elements included on the screen. There should be a logical reason for inclusion of the data elements. For example, you would not want to put an “opt in or out of the directory” field on the chart location system screen. 3. Why is the type of data entry appropriate for the data element? Some data fields have only 1 method of data entry that is appropriate and some have a variety. The student should demonstrate that thought went into the decision and that the field type selected is appropriate. 4. How did you design data quality into the screen? The student should discuss choices such as the following: •
Choice of data entry method
•
System links to hospital information system or other system that provides collected data that then can be used to populate data in the Electronic Health Record (EHR)
•
Use of data dictionary so that you can only enter valid entries
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Section 5 Information Technology and Systems 298
References Abdelhak et al. Amatayakul Murphy Sayles and Trawick Williams
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Section 5 Information Technology and Systems 299
CASE 5-6 System Selection
Triad Hospital System comprises 6 hospitals. Corporate has asked the 6 HIM directors to select the electronic document management system (EDMS) that will be used by all 6 of the hospitals. Three of the hospitals want EDMS Plus, and the other 3 want HIM EDMS. No evaluation methods were established during the planning stage of this system selection. The HIM directors looked at the demonstrations and the responses to the requests for proposals (RFPs) before voting; none of the directors are willing to change their votes.
Questions and Suggested Answers 1. What evaluation criteria could have been in place to prevent this stalemate from occurring? There could have been a point system assigned so that there was a more objective method of selection. Points could be assigned as to how well the systems matched what you were looking for in the RFP. Points could also be assigned for responses from references, site visits, and reactions to the demos. Prior to the actual section process, they should choose the method to be used in the event of a tie. The number of people in the decision-making process could be an odd number, thus ensuring a tie would not happen. Also, there should have been input from other users. 2. Who else should have been involved in the decision-making process? There should have been physicians, nurses, other clinical departments, HIM staff, administration, and other stakeholders. Getting the input from the stakeholders helps to obtain buy-in and helps ensure that you will select a system that meets the needs of the organization. 3. What lessons should the facility learn from this experience? The facility should learn that a little bit of work on the front end of the system selection process can keep many problems from arising. The process that they used was very subjective and ended up pitting the HIM directors against each other, thus making the process adversarial instead of a team effort. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 5 Information Technology and Systems 300
References Abdelhak et al. Amatayakul Hebda et al. Johns LaTour and Eichenwald-Maki Murphy Sayles Sayles and Trawick Wager et al.
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Section 5 Information Technology and Systems 301
CASE 5-7 System Life Cycle
You recently heard about the concept of system life cycle in your HIM course. You really do not understand what it is. You know that it has something to do with the different stages of the information system, but you do not understand what those stages are and what would be included in each of the stages.
Questions and Suggested Answers Perform some research to find the following information about system life cycle and write up your findings. 1. What are the stages of the life cycle? There are some differences in the different models but one option is analysis, design, implementation and maintenance and evaluation, and obsolescence. 2. How can you tell which stage an information system is in? You can compare what is going on with the system and compare it to the definition of the various stages. Examples of each stage are provided in the answer to the third question. 3. Cite at least 2 specific examples of how information systems could fall into each of the categories. •
Analysis o You are considering implementing a data warehouse. o You are conducting a cost benefit analysis on the feasibility of a clinical decision support system.
•
Design o You are developing the functional requirements for an EHR.
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Section 5 Information Technology and Systems 302
o You are reviewing the response to an RFP for a new picture archival communications system (PACS). •
Implementation o You are developing screens that will be used in the chart locator. o You are testing the new release of information system. o You are adjusting the settings that control the computer. o You are doing some programming to customize the system. o You are creating reports. o You are conducting training.
•
Maintenance and Evaluation o The back-up for the day is completed for the master patient index. o The lab information system is working well and meeting the needs of the organization.
•
Obsolescence o This stage is frequently omitted from the list of stages of the information system life cycle. o The system does not meet your needs anymore because it does not collect the data that you need. o The system is down frequently. o The technology used is replaced with another technology. o The vendor has sunsetted the product.
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Section 5 Information Technology and Systems 303
o New laws have been passed that require so many changes that it is more feasible to replace the system than update it. 4. What is the HIM role in each of the stages? Students can give many examples of how HIM professionals contribute to each stage. Some examples are provided in the following: •
Analysis: The HIM professional can assist in the planning of new systems to be implemented.
•
Design: The HIM professional can be involved in the development of the functional requirements and the RFP. He or she can also be involved in the system selection.
•
Implementation: The HIM professional can be instrumental in many functions, including screen design, report design, testing, training, and project management among others.
•
Maintenance and Evaluation: The HIM professional can be involved in testing after updates, training, report generation, and much more.
5. How can you plan for the obsolescence of the information system? This is an important part of your information system strategic plan. You need to constantly monitor your systems and predict when systems will need to be replaced. These predictions can be based on changes in the organization, in the healthcare environment, in technology, in legislation, or other changes. Accurate predictions help you ensure that you have the funds and resources available when you do have to update the system. It also helps you know when to start the planning process, so that the new system is in place prior to the complete collapse of the obsolete system.
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Section 5 Information Technology and Systems 304
References Abdelhak et al. Johns LaTour and Eichenwald-Maki Sayles and Trawick
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Section 5 Information Technology and Systems 305
CASE 5-8 Data Collection Questionnaire and Interview Questions for Systems Analysis
The HIM director has asked you, the assistant director, to represent the department on the Electronic Document Management System (EDMS) Steering Committee. At the first meeting, you were asked to develop a questionnaire and the interview questions that will be used to collect information from users about the functionality they need in an EDMS. You know how important this system is to the hospital, and that administration is anxiously awaiting the findings, so you want to make sure that you use good form design principles and good questionnaire/interview design principles. You also want the questionnaire and interview questions to be comprehensive.
Questions and Suggested Answers Develop the questionnaire and the interview questions to be used. Include both open and closed questions. Write 2 paragraphs to describe why you chose the questions you selected for the questionnaire and for the interviews. Good form design would include things such as the following: •
Descriptive title
•
Good instructions
•
Easily completed through use of check marks, circles, and so on
•
Easily understood by respondents
•
Logical layout
•
Appropriate font, margins, and font size
•
Easy to analyze
The questions in the questionnaire should cover all aspects of the system including, but not limited to, data collection, reporting, functionality, management controls, security, and accessibility. The © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 5 Information Technology and Systems 306
interview questions should be open-ended and encourage the interviewee to provide you with information that you may have missed in the questionnaire. Time and the data analysis should be considered when developing the questionnaire and interviews. You may need 3 questionnaires to be able to effectively ask the questions that are appropriate for each type of user. The questions for users, managers, and administration may be so different that 1 questionnaire may not meet your needs. Interview questions should be designed appropriately for the people to be interviewed. The questions should be designed to get the interviewee talking and should be open-ended in design.
References LaTour and Eichenwald-Maki Sayles and Trawick
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Section 5 Information Technology and Systems 307
CASE 5-9 Developing Data Collection Plan for Systems Analysis
Your facility has decided to purchase an EDMS. You have just developed a survey instrument with interview questions to be used in determining the functional requirements of the system. Determine who should be included in the survey and interviews. Your facility has 1,800 employees and 500 physicians on medical staff. With your resources, there is no way that you can include everyone. You want to include as many people as possible, but you do not have a lot of time and personnel to do the data collection and analysis. You also want to include clinical and nonclinical users throughout the facility. At this time, you do not have to specify the number of surveys and interviews to conduct; the committee as a whole will make that decision.
Questions and Suggested Answers 1. Who should be interviewed as part of the project (provide titles and/or categories of employees, not names)? There could be many job titles that could be listed. Examples include the following: •
Physicians
•
Nurses
•
Clinical staff members
•
Coders
•
HIM manager/director
•
Clinical department managers
•
Researchers
2. Who should be administered a questionnaire as part of this process (provide titles and/or categories of employees, not names)? © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 5 Information Technology and Systems 308
There could be many job titles that could be listed. Examples include the following: •
Physicians
•
Nurses
•
Clinical staff members
•
Coders
•
HIM manager/director
•
Clinical department managers
•
Release of information coordinator
•
Tumor registrar
•
Unit secretaries
3. Why did you choose these job titles? These are all users of the medical record. The users listed in the interview category are heavyduty users of health information. 4. How would you choose the specific individuals in each job category who should be included? It is important to include the appropriate individuals in the interview process. These users need to be experienced in their roles. They also need to perform a variety of functions so that a broad coverage is obtained. If the questionnaires utilize computer technology or Scantron analysis, then a very large sample size can be obtained. 5. Would you recommend paper or web-based surveys? Explain your decision. If the student chooses paper surveys, he or she could use justifications such as the employee’s comfort level or ease of distribution. The paper surveys could be Scantron sheets that would enhance data collection and analysis. If the student chooses web-based surveys, he or she could justify the selection with quick distribution and ability to return the surveys quickly. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 5 Information Technology and Systems 309
References Abdelhak et al. Sayles and Trawick
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Section 5 Information Technology and Systems 310
CASE 5-10 Information System Project Steering Committee
The Information System Steering Committee in conjunction with administration has decided to implement a computerized physician order entry (CPOE) system. A separate CPOE committee is being created to control the implementation of the CPOE with the Information System Steering Committee providing guidance.
As project manager, you have been given the responsibility for selecting the appropriate individuals—those with a vested interest in the CPOE—for inclusion on this committee.
Questions and Suggested Answers 1. What departments would you want represented on the CPOE committee? Representatives should include at least the following: •
Health information management
•
Nursing
•
Key clinical areas such as pharmacy, lab, radiology, and cardiovascular services
•
Administration
•
Information system staff
2. Who should the CPOE committee report to? The Information System Steering Committee, which oversees all projects. 3. How frequently would you recommend that the CPOE committee report to the Information System Steering Committee? Monthly at the beginning of the project, but as the project gets closer to implementation, the reporting should escalate to weekly and at the end possibly even more frequently. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
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4. What responsibilities should the CPOE committee have? •
Coordinate implementation of system
•
Participate in testing, training, configuring system, and other implementation tasks
•
Assist in problem resolution
•
Manage resources including staff, budget, and time
•
Be a liaison between the hospital and the vendor
References Abdelhak et al. Amatayakul Hebda et al. LaTour and Eichenwald-Maki Murphy Sayles and Trawick Wager et al.
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Section 5 Information Technology and Systems 312
CASE 5-11 Developing a System Selection Plan
Your facility does not have an existing voice recognition system. You are part of the 5-member team responsible for selecting a voice recognition system for your facility. The functional requirements and the request for proposal (RFP) have been developed. The RFP is due back from the vendors in 1 week. Your facility wants to make the decision about which system to choose within 3 months. Your assignment is to evaluate the RFPs returned and to develop a plan to guide the team in the evaluation and selection of the final system.
Questions and Suggested Answers Your plan should answer these questions: 1. What process(es) will be used to evaluate systems? There should be a formal evaluation process. This process should be objective. One way to encourage objectivity is to develop a point system that is applied to each product under consideration. There should be a way to break a tie, just in case. The steps in the evaluation process should include the following: •
Review of RFP
•
Reference checks
•
Site visits
•
Demonstrations
2. How will you evaluate the individual RFPs? The following are examples of what the student may state: •
Review of functional requirements available versus required
•
Stability of vendor
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•
Cost
•
Compatibility with existing systems
•
Resources to implement and maintain system
3. Who will be involved in the system selection process and what will be their roles? •
Project manager: This individual is responsible for the overall project, so should be involved in all stages of the system selection.
•
CIO: The CIO should function in an advisory capacity. He or she is responsible for the overall information management of the facility, including the specific system.
•
Administration: He or she is the representative from administration responsible for ensuring that the decisions made fit into the overall plan for the facility.
•
Users: The users are responsible for ensuring that their needs are met. The users should include physicians, nurses, unit secretaries, and others who will use the system.
•
Managers from clinical areas: The managers are there to ensure that the needs of their departments are met and that the system will allow the facility to meet legal and accreditation requirements.
4. Of all the evaluation methods used, which one do you believe should have the most impact on your decision? Why? The student could choose any of the evaluation tools and use multiple reasons for their decision. Examples of each include the following: •
Site visit: These people use the system in a live environment and therefore are fully qualified to judge the capabilities of the system.
•
Response to RFP: The response to the RFP is measuring how well the system meets your needs—not the needs of anyone else.
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•
References: You can do multiple calls to check on how well the system is working for the organization. You also can call facilities not on the list provided by the vendor.
•
Demonstrations: This format allows us to get the users involved and to acquire input from as many people in the organization as possible.
References Abdelhak et al. Hebda et al. LaTour and Eichenwald-Maki Sayles Sayles and Trawick Wager et al.
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 5 Information Technology and Systems 315
CASE 5-12 System Selection
Island Palms General Hospital has an existing admission discharge transfer (ADT)/MPI system that was implemented 20 years ago. It was developed in-house. By now, all of the original programmers have resigned or retired. It is cumbersome to manage and to update to meet the current needs of the hospital. Therefore, the decision has been made to purchase a new system. An RFP was sent out to 2 vendors—System Patient Management, Inc. and System Patient Tracking, Inc. Key portions of the RFP have been summarized to allow for easy comparison. The responses to the functional requirements have also been provided for review. Demonstrations were conducted at the hospital and both systems looked good. The MPI module is preferred on System Patient Management, and the ADT system is preferred on System Patient Tracking; however, both systems were received favorably. The committee went to see both systems in operation and liked them both. References were checked on both systems. The references for System Patient Tracking were glowing. All of them said that the system was good and the people were great to work with because they wanted their new company to succeed and to grow. The references on System Patient Management were excellent, too. The only negative about System Patient Management was that the company was too large and was sometimes slow to respond to what the company saw as minor problems. The next release of System Patient Tracking is due out in 6 months and of System Patient Management is due out in 8 months. You expect to implement your system in 1 year. The Committee has used Tables 5-3, 5-4, and 5-5 to summarize and compare the information that was gathered, and is now ready to vote on which system to purchase.
Questions and Suggested Answers Which system will you select? Justify your response. The student has 2 choices—System Patient Management and System Patient Tracking. If the student chooses System Patient Management, he or she could justify it using the following reasons: © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
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•
Business is more stable because vendor has a long track record in the business.
•
The only customizable functional requirement in the RFP is biometrics, which is not essential to the operation of the system.
•
The other system has electronic insurance verification as a customizable function, which would increase the cost of the system and the work involved to maintain it.
•
The other system only has 8 installs, so there may still be bugs.
•
By the time the system is selected, the contract is signed, the infrastructure is updated, and preliminary work is performed, the new release will be available to implement and will have significant new functionality.
If the student chooses Patient System Tracking, he or she could use the following reasons: •
The vendor is responsive to the user’s needs.
•
The system is cheaper, both to implement and to operate for 5 years. System Patient Management costs $552,000 to implement and a total of $776,000 to implement and operate. System Patient Tracking costs $535,000 to implement and a total of $727,000 to implement and operate for 5 years. This is a difference of $49,000.
•
By the time the system is selected, the contract is signed, the infrastructure is updated, and preliminary work is performed, the new release will be available to implement and will have significant new functionality.
•
It will operate on Oracle.
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References Abdelhak et al. Amatayakul Hebda et al. LaTour and Eichenwald-Maki Sayles Sayles and Trawick
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 5 Information Technology and Systems 318
CASE 5-13 System Testing Plan
You are in the process of implementing a new release of information (ROI)/accounting of disclosure system. You have an existing computerized release of information system, so the employees are comfortable with the technology—they just have to learn how to use the new one.
Questions and Suggested Answers As part of the implementation plan for the new release of information (ROI)/accounting of disclosure system, you will need to develop a testing plan that should include the following: 1. Testing that needs to be conducted prior to implementation: •
Volume testing
•
Functionality testing
•
System testing
•
Integration/interface testing
2. A minimum of 6 scenarios that you would encounter when using the system that can be used during testing (students can come up with many different scenarios). Six examples follow: •
A letter has been sent to an attorney requesting prepayment and the payment has been received. You now need to post the payment and document that the information has been submitted.
•
A request for medical records has been received from an insurance company that you have never had a request from before. Before you can complete entry of the new request, you need to add the insurance company to the database.
•
A patient calls to check on the status of his or her request for medical records.
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•
Your director wants to know the number of outstanding requests and the average turnaround time of the completed requests.
•
You have received a request from an insurance company for a patient’s record. You do not have any information on a patient by that name.
•
You received a subpoena requesting a certified copy of records.
3. List of resources needed to complete the testing: •
Users
•
Computers in testing area
•
Test scenarios
•
Space for testers to work
•
Technical staff to work with testers
4. What to do when a problem is identified? Open trouble ticket or use other methods to document the problem. The documentation must give very specific information on the problem. After the problem has been corrected, all functions need to be retested. 5. How you will know the system is ready for implementation? When testing is completed (with all problems being resolved) and the system is stable. 6. Who should be included in the implementation of the testing plan? A number of different people such as users and technology support should be included.
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
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References Abdelhak et al. Amatayakul Hebda et al. Sayles Sayles and Trawick Wager et al.
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 5 Information Technology and Systems 321
CASE 5-14 Workflow Technology
You started as the new Director of HIM last week. Your department began using workflow technology 6 weeks ago with a relatively new EDMS, which was implemented a year ago. With the implementation of workflow, the department started coding and analyzing charts online. Other tasks involved in the workflow are: •
Notifying risk management of issues identified
•
Communications with physicians
•
Communications with business office
•
Communications with supervisor
•
Routing charts that meet criteria to performance improvement
One of the first things that you noticed when you started work was the stress level of the coders— they are panicking. You also found that the billing hold report is at $2.4 million, when the expected level is below $800,000. In a meeting with the coders, they all tell you that they hate using the new system. You also learn that much of their distress is a result of the fact that they were not involved in the selection or implementation of the new system. In addition, they had only a short training period, so they do not feel comfortable using the system.
Questions and Suggested Answers 1. How would you proceed to resolve the problems? You could first meet with the coders to discuss the situation. You may need more information to completely identify all of the issues that need to be addressed in order to solve the problems. You would immediately schedule additional training for the coders. Since this training will take the coders away from coding the charts for a significant amount of time, you would need to notify administration about the situation in order to prepare them for overtime and/or an increased discharged not final billed report (DNFB). You would also let the coders know that they will be involved in any systems that impact them in any way in the future. You would also check with other users of the workflow system to see if they feel the same way and if they need further training as well. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
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2. What will you do with future system selections to ensure that these same problems do not occur? Everyone affected by the system should be involved when possible. They also need to be prepared through change management and training.
References Amatayakul American Health Information Management Association (AHIMA) Mahoney Sayles and Trawick
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Section 5 Information Technology and Systems 323
CASE 5-15 Developing a Workflow Plan
You just started as the new Director of HIM at a 200-bed hospital. This hospital is in the process of developing a new EDMS. One of the key benefits of this system is workflow technology. Charts will be routed to coding, analysis, documentation improvement, quality improvement, and risk management, as appropriate.
Questions and Suggested Answers Make your recommendations for the system by answering the following questions: 1. Should we use push or pull workflow? Justify your decision? The student could choose either option. Justification for push workflow could be that it allows the manager to control what criteria is used to distribute work and prevents staff from picking and choosing the easy charts to code, or that it is quicker when the staff do not have to make decisions but have new work automatically presented to their workstations. Pull workflow justification could be that it allows staff to make decisions based on policies and procedures. 2. What specific tasks would you recommend being included in the workflow? The student should provide specific tasks that are typically performed in the functions identified in the case study. Examples of these tasks are as follows: •
Coding chart
•
Requesting notification when document needed for coding is present
•
Physician queries
•
Notifying risk management of possible risk management issue documented in chart
•
Notifying risk manager of inappropriate documentation identified
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•
Notifying physician of deficiencies
•
Notifying analyst of chart that is ready to be reanalyzed
•
Assigning chart to analyst for initial analysis
•
Routing chart to document improvement coordinator
•
Routing chart that meets certain criteria to quality improvement coordinator for inclusion in review
3. What order of these tasks would you recommend? Justify your recommendation. Electronic workflow is not like the paper record workflow. There does not have to be one workflow where the chart is assembled, analyzed, coded, and so on in sequence. In electronic workflow, the chart can be provided for multiple tasks at the same time. The answer to this question should not give a list of tasks (i.e., task 1, task 2, and task 3). In this example, the chart can be queued up for multiple tasks based on criteria established. For example, the chart could be queued up to be coded and analyzed immediately upon scanning. Either task could be done first or they could even be done simultaneously. The chart could be routed to documentation improvement when all required documents are present. The chart could be routed to quality improvement when a certain criterion is met, such as when the cholecystectomy code is assigned or a blood transfusion is given. The chart would only go to risk management when someone like a coder or documentation improvement coordinator sees something in the chart that the risk manager should see. Flexibility is critical to electronic workflow. 4. Draw a diagram showing the flow of tasks, including both linear and nonlinear steps in the diagram. This diagram will vary by student but should show all steps and clearly show what steps can be done at the same time and which ones must be completed in order 5. 5. What rules could you establish to route charts to each of the area? 6. Why did you choose these rules? Examples of rules for each of the area include the following: © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
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•
Coding examples: Oldest chart based on discharge summary is sent to the first available coder. When the physician answers the physician query, the chart is automatically routed back to the coder who sent the query, and the insertion of the discharge summary into the record could initiate the return of the chart to the coder who identified a need for it.
•
Analysis: Oldest chart in queue is sent to the first available analyst, deficiencies are sent to all physicians simultaneously.
•
Documentation improvement: A page from the chart could be sent to a physician to show him or her poor documentation practices in charting. A record, or a page from a record, could be routed to supervisor for his or her input.
•
Quality improvement: A chart meeting criteria such as blood transfusion, specific procedures, random sample, and so on are automatically routed to quality improvement. A specific chart could be routed to physician for review; then the results of the physician review could be routed back to quality improvement.
•
Risk management: The chart could be routed to a hospital attorney for review. The chart could be routed to a defendant in a court case for review, or a chart could be routed to a staff member to complete incident report.
7. As the HIM director, which reports would you want to receive on a regular basis? Examples of these reports are as follows: •
Biggest offenders (tasks undone after specified period)
•
Number of charts to be coded
•
Average turnaround for each task
•
Productivity
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
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References Amatayakul LaTour and Eichenwald-Maki Mahoney Sayles and Trawick
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Section 5 Information Technology and Systems 327
CASE 5-16 Goals of the Electronic Health Record (EHR)
Your facility, Good Samaritan Hospital, is implementing a new EHR. You are excited about the positive impact that the EHR will have on your organization. During the planning stage, the hospital developed goals that it would like to accomplish with this implementation. Administration has said that these goals are firm expectations for the team and the system. The goals of the system are to: •
Reduce HIM staff
•
Reduce time required to access health information
•
Improve quality of care
•
Decrease the number of duplicate and unnecessary tests
•
Reduce the cost per case
Questions and Suggested Answers 1. Critique the goals provided. Students should apply what they have learned about goals to the goals provided. 2. How can the goals be improved? The goals are very brief, so the team does not have a lot of direction. Also, they are not measurable. 3. Rewrite the goals based on your evaluation. Students should make sure that the goal is measurable. 4. How can you monitor to determine if you met the goals? •
Reduce HIM staff Compare how many staff members you had before and how many you have 1 year later.
•
Reduce time required to access health information
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Section 5 Information Technology and Systems 328
Compare how long it took to access patient information prior to implementation compared to after implementation. •
Improve quality of care Many different things could be listed here. An example is reduction in medication errors.
•
Decrease the number of duplicate and unnecessary tests The number of duplicate and unnecessary tests prior to implementation compared to after implementation.
•
Reduce the cost per case The average cost per case before implementation versus after.
References Abdelhak et al. Amatayakul Hebda et al. LaTour and Eichenwald-Maki Wager et al.
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 5 Information Technology and Systems 329
CASE 5-17 Computerized Provider Order Entry Implementation
Your facility has made the decision to implement a new computerized provider order entry (CPOE) system. The Steering Committee has to decide which of the following implementation strategies to utilize: a.
Implement the CPOE on all units at the same time
b.
Implement the CPOE unit by unit
c.
Implement the medication orders unit by unit
d.
Implement the medication orders on all units at the same time
Questions and Suggested Answers 1. Which of the implementation strategies would you choose? Justify your decision. The student could choose any of the options. An example of justification for each is provided in the following. •
Implement the CPOE on all units at the same time The benefit of this method is that you do not drag the implementation out. It is done in a very short time.
•
Implement the CPOE on 1 unit at the same time This way you are able to test both systems at the same time but impact only 1 unit, so the impact on the organization as a whole is minimal.
•
Implement the order entry system unit by unit Because you are implementing only 1 part of the system and on only 1 unit, the impact on the unit and the organization is reduced.
•
Implement the results reporting system unit by unit Because you are implementing only 1 part of the system and on only 1 unit, the impact on the unit and the organization is reduced.
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Section 5 Information Technology and Systems 330
•
Implement the order entry system on all units at the same time Implementing only 1 part of the system decreases the impact of the implementation of the organization. Implementing it simultaneously on all units speeds up the process.
•
Implement the result reporting system on all units at the same time Implementing only 1 part of the system decreases the impact of the implementation of the organization. Implementing it simultaneously on all units speeds up the process.
References Abdelhak et al. Hebda et al. Sayles Sayles and Trawick Tan
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 5 Information Technology and Systems 331
CASE 5-18 Normalization of Data Fields
You have recently been hired at Black Hills Hospice to help with report generation. On your first day, you start investigating the databases that you will be working with. You see room for improvement in the first database that you look at—Human Resources. This database does not include payroll.
Questions and Suggested Answers 1. Normalize the data fields to allow for more flexibility in reporting. Identify gaps in the human resources data collected and present the results of your investigation in a table with 1 column for the original data fields and 1 column for the normalized data fields. Include recommendations for additional fields to be collected. Data fields to consider are as follows: 1. Full name 2. Address 3. City, state, ZIP 4. Phone 5. Social Security Number 6. Race 7. Gender 8. Degree/major 9. Date of last evaluation 10. Department 11. Start date 12. Credentials 2. Include recommendations for additional fields to be collected. See the fields at the end of Table 5-18A for examples.
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Table 5-18A Normalization of Data Fields Original Data Fields
Normalized Data Fields
Full name
Last name First name Middle initial
Address
Address 1 Address 2
City, state, ZIP
City State ZIP
Phone
Phone
Social Security Number
Social Security Number
Race
Race
Gender
Gender
Degree/major
Degree 1 Major 1 Degree 2 Major 2
Date of last evaluation
Date of last evaluation
Department
Department
Start date
Start date
Credentials
Credentials 1 Credentials 2 Position Previous position Employee ID Probation status Previous department
© 2014 Cengage Learning ®. All Rights Reserved. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 5 Information Technology and Systems 333
References Johns LaTour and Eichenwald-Maki
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Section 5 Information Technology and Systems 334
CASE 5-19 Human Resource Database
You are Director of the HIM Department of a home health organization. You constantly have to ask Human Resources for reports on your staff. Because of the frequency of these requests, you have asked for access to the Human Resources system. Unfortunately, their response is that the system will not allow you to access only your HIM staff, but would instead provide you access to all employees. Because administration will not allow you to have access to all Human Resources data, you have decided to create your own mini-database. This mini-database will help you in many ways. The following are examples of how you will use this database: •
Track salaries
•
Track open positions
•
Track when performance evaluations are due
•
Track anniversary dates
•
Track birthdates
•
Identify employees on probation
Questions and Suggested Answers Use Microsoft Access to create the database. Design a data entry screen that utilizes good screen design. Populate the database with 5 test employees and generate 2 reports: a list of all employees by anniversary date and a list of employees on probation. The reports generated by the student should have the appropriate data fields and show the 5 test employees who were populated into the database. It should use good report design principles and look like more work was done than using the report wizard of Microsoft Access. The student should also provide the file so that you can confirm the data entry screen design and the data quality that is built into it.
Reference Abdelhak et al. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 5 Information Technology and Systems 335
CASE 5-20 Tumor Registry System Questionnaire
You have been asked to develop the questionnaire that will be used to collect functional requirements for the new tumor registry system at a cancer treatment facility. This questionnaire will be sent to the tumor registrars and the tumor registry supervisors and their customers, including the Cancer Committee, the Cancer Program director, oncologists, and the Vice President of Research. The questionnaire should use good design principles, be comprehensive, and should address accreditation, state cancer reporting, institutional needs, and user needs.
Questions and Suggested Answers Students should have questions about the following areas: •
Data analysis
•
Data collection
•
Required tracking
•
Required reporting
Examples of questions include the following: •
What works now?
•
What does not work now?
•
What data are needed?
•
What functionality is needed?
The questionnaire must be appropriate for the wide range of customers it will reach and must be written with this in consideration. Both open-ended and closed-ended questions should be used. The format of the questionnaire should be designed to facilitate analysis, which means that you probably want most of the questions to be closed-ended, using a few open-ended questions as well. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 5 Information Technology and Systems 336
References Abdelhak et al. LaTour and Eichenwald-Maki Sayles and Trawick
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 5 Information Technology and Systems 337
CASE 5-21 Bar Code Standards
You have been given the responsibility of developing the standards for using bar codes on medical record forms. Your facility plans to implement an EHR in 5 years and wants to take the intermediary step of purchasing an EDMS system. They want to implement the imaging system in about 2 years. They believe EDMS is an important step, since they want to stop microfilming and the images can be linked to the EHR. Because it will take a while to implement the EDMS system, your facility has time to revise all medical record forms to add bar codes so that when the system is implemented, the time required to scan and index the records will be minimal and the quality of the indexing will be high.
Questions and Suggested Answers 1. What bar code format do you recommend? Why? The most likely bar code choice would be code 39, which may also be called code “3 of 9.” Student may choose another barcode, but this is one of the most common formats used because it accepts both alpha and numeric characters. 2. What other forms design and bar code issues should you take into consideration? The student should address at least the following issues: •
Size of barcode
•
Content of barcode
•
Placement of barcode on form
•
Scanners to be used
•
How you will, or if you will, barcode documents obtained from outside the organization.
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Section 5 Information Technology and Systems 338
References Abdelhak et al. American Health Information Management Association (AHIMA) Dunn HIMSS LaTour and Eichenwald-Maki
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 5 Information Technology and Systems 339
CASE 5-22 Bar Code Policy
You have been given the responsibility of developing the standards for bar coding the forms that will be scanned into the new imaging system your facility is implementing in about a year. You have 6 months to have all of the forms redesigned to accommodate the bar code.
Research the use of bar codes and use the information that you find to develop your policy. The policy should be written in the policy and procedure format and should include specific guidelines that forms developers should follow.
Questions and Suggested Answers The student should address the following: •
Format of the barcode
•
Placement on the form
•
Size of barcode
•
Type of scanners to be used
The student could make a number of different recommendations. •
Consistent placement of the barcode on the forms in order to speed scanning
•
Address regular forms design issues such as font, margins, shading, NCR paper, size of paper, color of paper, and use of color on form, headings, hospital name, and form number.
References Amatayakul American Health Information Management Association (AHIMA) © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 5 Information Technology and Systems 340
Dunn HIMSS LaTour and Eichenwald-Maki
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Section 5 Information Technology and Systems 341
CASE 5-23 Conversion of Admission Discharge Transfer (ADT) System
The service codes for your existing Admission Discharge Transfer (ADT) System and the new system do not match. The old system uses a 2-digit numeric code to indicate service, while the new system will accept up to a 4-digit alphabetic code. The hospital has decided that it will use 2- to 4digit codes depending on which format is more user recognizable.
Questions and Suggested Answers Review the codes utilized by both systems and develop a map that will be used by the programmers to convert the data from the old system to the new system. Use Table 5-7 from the case study book. Table 5-7 Codes in New ADT System Codes in New ADT System New System
Service Description
Code ALL
Allergy
BURN
Burn
CARD
Cardiology
CVS
Cardiovascular Surgery
DERM
Dermatology
ENDO
Endocrinology
ENT
Otorhinolaryngology
GI
Gastroenterology
GYN
Gynecology
ID
Infectious Disease
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Section 5 Information Technology and Systems 342
NEO
Neonatal
NEPH
Nephrology
NEUR
Neurology
NSU
Neurosurgery
OB
Obstetrics
ORT
Orthopedics
PUL
Pulmonology
MED
Medicine
SUR
General Surgery
© 2014 Cengage Learning ®. All Rights Reserved.
References Abdelhak et al. Amatayakul Sayles and Trawick
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Section 5 Information Technology and Systems 343
CASE 5-24 Admission Report Design
Your facility is about to implement a new hospital information system. The reports have been distributed to the members of the team for design. You have been given the responsibility of designing the admission report, which will come from the Hospital Information System and be used by multiple departments in identifying the patients who have been admitted to the hospital as an inpatient each day. You do not like the current report, so you are essentially developing a new one. It should include the appropriate data elements, date, title of report, time ran, and other data as needed.
Questions and Suggested Answers 1. What recommendations do you have for this report regarding the following? •
Print orientation: Choose landscape in order to accommodate all the necessary data elements.
•
Timing of printing: If this is printed in information system for other departments including HIM, it should be done daily sometime between midnight and when the staff first arrives. If the system allows the staff to print their own report, then they should print it out as one of the first tasks of the day.
•
Content of report: The patient name, medical record number, service, physician, unit, bed, name of facility, title of report, date/time report printed, and date of admission.
•
Ad hoc versus standard report: Choose standard report.
•
Who receives report: This will vary by facility, but should include at least HIM, utilization review, and admissions.
•
Other o Types of paper, such as regular versus green and white bar paper
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Section 5 Information Technology and Systems 344
o Font size o Privacy issues 2. Based on these recommendations, design the administrative report. Each student’s report will be different. They should not only address the above issues but also use good report design principles.
References LaTour and Eichenwald-Maki Sayles and Trawick
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 5 Information Technology and Systems 345
CASE 5-25 Choosing Software Packages
Technology Support is installing new computers throughout the HIM Department. The existing computers are slow and many freeze up several times a day. You receive an e-mail from the Supervisor of Technology Support relaying that Technology Support wants to install the same systems on all of the computers to make things easier. This is fine with you because that gives you flexibility in moving employees around the office, plus employees will only be able to access the data if they have the proper access controls. Technology Support is planning to load the following software packages on all of the computers: •
Chart locator system
•
Hospital information system
•
Financial information system
•
Chart deficiency system
•
Release of information system
•
Encoder/grouper
•
Electronic health record
You then read in the e-mail that Technology Support plans to install Microsoft Office only on the secretary’s and the director’s computers. You know that the facility has a site license for Microsoft Office, so expense is not the issue.
Questions and Suggested Answers 1. As director, how would you respond to the supervisor’s plan for Microsoft Office? Justify your stance by providing specific HIM tasks that require this software. You would be totally against this plan and would be vocal in your objections. You would probably call the information systems (IS) supervisor rather than solely relying on e-mail, because you want to state firmly your case against loading Microsoft Office only on the secretary’s computer and your computer. Students have a lot of flexibility with this option. Examples include the following: © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 5 Information Technology and Systems 346
•
Employees need to complete weekly productivity report.
•
Employees need to access hospital forms such as a vacation request that is stored on the intranet in Adobe format.
•
Employees must report productivity each month.
•
Employees may have to type memos and the like periodically.
2. What other software/systems would you request? You would also ask for a tumor registry system. You would also recommend an Internet browser and Adobe Reader. Not every staff member may need access to the Internet, but some may need access to the organization’s intranet.
References Burke and Weill Hebda et al. Sayles Sayles and Trawick
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Section 5 Information Technology and Systems 347
CASE 5-26 General Office Software
The staff in the HIM Department use general office software just like any other office. The general software used includes spreadsheet, calendar/e-mail, word processor, database, and presentation applications. The management team uses these products the most.
Questions and Suggested answers Identify 5 specific ways that each of these general office software products can be used by the HIM staff. The student can come up with many ways that the products can be used. Some of these are as follows: 1. Spreadsheet •
Track expenditures so the department does not go over budget for the month
•
Generate graphs to be used in meetings
•
Calculate transcription incentive pay
•
Trend productivity
2. Word processor •
Type memos
•
Create fliers to advertise HIM week
•
Write policy and procedure
•
Justify budget request
•
Create a productivity report
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Section 5 Information Technology and Systems 348
3. Calendar •
Schedule meeting with staff in other areas of facility
•
Maintain contact information on vendors
•
Send e-mail
•
Send out information to list serves
•
Access calendar from home to check what time a meeting is
4. Database •
Keep up with staff in department
•
Manage mailing lists
•
Generate reports
•
Abstract data
•
Build data quality into abstracting
5. Presentation software •
Create presentation for new chart locator training for staff
•
Create presentation for committee
•
Present data to administration
•
Show before and after pictures to group
•
Give employees copies of presentation for them to use in taking notes
Reference Burke and Weill
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Section 5 Information Technology and Systems 349
CASE 5-27 Selecting an Internet-Based Personal Health Record (PHR)
You are a patient advocate. A patient of your facility has come to you and asked for advice in selecting an Internet-based Personal Health Record (PHR). She saw a physician talking on the news during the aftermath of a recent devastating tornado about how hard it was to treat patients without basic health information. The patient has not been able to get this out of her mind. She wants to ensure that her patient information is available if she finds herself or her family members in a similar situation.
Go to http://www.myphr.com to review 3 of the Internet-based PHRs that are available on the market.
Questions and Suggested Answers 1. Create a table for use in comparing the various functions of the PHRs. For each PHR reviewed, determine if you would recommend the product to the patient. Justify your recommendations. Students should review 3 of the products listed on the website and provide a brief overview of each product on issues such as cost, space allocated, type of data stored, robust functionality, and Internet access. Each student should indicate whether he or she would recommend the product. 2.
The patient asks which of the 3 you would choose for your own PHR. What would you tell her? Students should each then choose the one that they prefer and would choose if they were to develop a PHR for themselves. They should each be prepared to justify the decision with specific examples of what made the PHR system so strong. Examples can be flexibility, accessibility, storage size, specific functionality provided, and so on.
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 5 Information Technology and Systems 350
References Amatayakul Sayles LaTour and Eichenwald-Maki
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 5 Information Technology and Systems 351
CASE 5-28 Data Warehouse Development Your facility is developing a data warehouse. The administrator has indicated that she plans to use the data warehouse for business, research, and clinical data analysis. Examples of the usage of the system include identifying which physicians make/lose money for the facility, determining the most profitable services, and analyzing best practices in patient care.
Questions and Suggested Answers You have been asked to determine which of your current systems should be included. You have also been asked to write a justification for each system to tell why you would or would not want to include it. Students could use many reasons to include or not include a system. A possible justification for each system is provided in Table 5-8. Table 5-8 System Justification System Justification System
Included Justification for Decision Yes/No
Patient satisfaction
Yes
This information would allow research on patient satisfaction by unit, service, and so on.
ADT
Yes
This
provides
the
patient
demographic
information that is the core database upon which everything else is built. Lab information system
Yes
A data warehouse should contain all clinical information for robust reporting and research.
Radiology information system
Yes
A data warehouse should contain all clinical information for robust reporting and research.
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Section 5 Information Technology and Systems 352
Picture Archiving and
Yes
A data warehouse should contain all clinical
Communications Systems
information
(PACS)
research—even images.
Nursing information system
Yes
for
robust
reporting
and
A data warehouse should contain all clinical information for robust reporting and research.
Fetal monitoring
Yes
A data warehouse should contain all clinical information for robust reporting and research.
Financial information
Yes
system
Financial
information
when
linked
with
clinical information can provide important information regarding best practices.
Human resource system
Yes
Adding human resource information allows you to study performance by staff member, will allow you to get into cost accounting.
Patient acuity system
Yes
Patient acuity systems allow you to compare patients who are similar in severity of illness.
Chart deficiency system
No
Adds no value to data analysis.
Quality indicator system
Yes
Allow analysis regarding quality of care to other information in system.
Chart locator system
No
Adds no value to data analysis.
Release of information
No
Adds no value to data analysis.
system © 2014 Cengage Learning ®. All Rights Reserved.
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 5 Information Technology and Systems 353
References Abdelhak et al. Amatayakul LaTour and Eichenwald-Maki McWay Sayles Sayles and Trawick
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 5 Information Technology and Systems 354
CASE 5-29 Data Tables You have been given the responsibility of populating the deficiency and form types that will be used by your new chart deficiency system. The old system has such poor data quality that you are starting from scratch. In the current system, the deficiency type and form number have no logical meaning. For example, the form type of “X” means operative note and “P” is cancer staging form.
Questions and Suggested Answers You have been provided with the templates for Tables 5-9 and 5-10 for completion. You are to choose logical codes whenever possible. The following are suggested entries for Tables 5-9 and 5-10. Table 5-9 Deficiency Type Deficiency Code
Deficiency Description
S
Sign
D
Dictate
C
Complete
T
Transcribe
W
Write
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© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 5 Information Technology and Systems 355
Table 5-10 Form Type Form Code
Form Description
DS
Discharge summary
HP
History and physical
OP
Operative note
TR
Tumor registry cancer staging
DO
Discharge order
AO
Admit order
FS
Face sheet
PA
Post anesthesia note
PN
Progress note
PO
Physician order
PQ
Physician query
© 2014 Cengage Learning ®. All Rights Reserved.
References Abdelhak et al.
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 5 Information Technology and Systems 356
CASE 5-30 Electronic Forms Management System
The facility where you work is completely paper except for laboratory, radiology, and dictated reports. The facility wants to implement an EHR in about 5 years. Time and money are preventing you from doing it sooner. In the meantime, you want to get a better handle on your forms management. Currently you are still creating your forms. You are having the forms printed off by your local printing company in large bulk and storing them in your materials management department. This is costly but effective. You tried just-in-time inventory, but this failed miserably because departments constantly failed to order supplies in advance. You are considering replacing the current method with an electronic forms management system. This system would allow you to design the forms and store the files on a centralized server. When a patient is admitted, a packet of admission forms would be printed based on the patient type. For example, physician order sheet, graphics, nursing notes, nursing assessments, and progress notes would be printed out for inpatient admissions. Individual forms could also be printed on demand. The patient name and other identifying information would print out on the form.
Questions and Suggested Answers 1. What are the pros of implementing a forms management system? •
Reduction of space taken up by forms in materials management
•
Reduction of money tied up on blank forms at any given time
•
Elimination of multiple versions being used across the facility
•
Units or departments never run out of forms
2. What are the pros of implementing a forms management system when you are planning to go to the EHR in 5 years? You are able to get people used to entering data online and you have data that can be analyzed from day 1 of the EHR. 3. What are the cons of implementing a forms management system at this stage? •
Would have to enter every form into the form management system
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Section 5 Information Technology and Systems 357
•
May need to upgrade printers on the unit
•
Would have to train staff on how to use the system
•
Would need to have back-up process so that work would continue when the system is down
4. Would you recommend doing this if you expect to implement an EHR in about 5 years? Justify your response. Students should take a stand on the issue and justify their decision. If they recommend the system, they would quote cost savings, flexibility of system, and that patient information is already on form, thus saving staff time. They could also say that this process would help them with the EHR implementation, since they would need to evaluate the documentation needs of the organization. If students recommend against the system, they may base the decision on the fact that by the time they get the system up and fully operational, it would be approaching the time to implement the EHR. They may feel that this takes their attention away from preparing for the EHR.
References Abdelhak et al. Access Patient Flow System
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Section 5 Information Technology and Systems 358
CASE 5-31 Failure of an Electronic Health Record (EHR) System
Magnolia Hills Hospital implemented an EHR about 6 months ago. Your administrator decided to pull the plug on the project a week ago because of all the problems that you were experiencing. Physicians refused to use the system. They made the nurses print out everything so they could review the patients’ medical records. The physicians would write orders on a piece of paper and ask the nurses to enter them into the order entry system. The few physicians who did try to use the system properly were still having problems. The system was down at least 2 hours a day, and many days for 4 to 5 hours. When the HIM Department printed out reports to satisfy release of information requests, what they received was more like screen prints than forms.
This system was the brainchild of Dr. Anderson. He is a retired transplant surgeon whose name is on the new transplant center building. He and a small group of his cronies were the ones who picked and controlled the implementation of the system. There was no input from anyone else other than the information technology (IT) staff. The screens are cluttered and difficult to use and do not have data quality built in. The system does not meet Condition of Participation, state licensing, and privacy requirements.
The HIM director, physicians, nurses, and other staff learned about the system 3 weeks before implementation. The HIM director was so angry at being left out of the loop that she took early retirement and left with only 2 days’ notice. Physicians’ training on the new system consisted of a demonstration of the system at the quarterly medical staff meeting. Nursing and other staff were given only 1 hour of training. Since the implementation of the system, there has been turnover in the hospital administrator position and a new HIM director has been hired.
Questions and Suggested Answers 1. What failures can you identify from the history of the EHR implementation? •
Lack of communication
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Section 5 Information Technology and Systems 359
•
Lack of HIM involvement
•
Lack of user involvement
•
Letting politics control actions at the expense of the organization’s best interest
•
Does not meet the needs of the user
•
Does not meet the needs of the organization regarding meeting accreditation, licensure, and regulatory requirements
•
Increased training
2. What should the hospital have done to prepare the staff for the EHR implementation? •
Get as many people involved as possible
•
Get the HIM involved
•
Get medical staff involved
•
Ensure that system meets needs of users and organization
•
Make sure that system was stable before implementation
3. The hospital wants to try to salvage the system if possible. What should they do now to prepare to reimplement the system? The system would have to be totally reworked prior to reimplementing it to ensure that it is stable and meets the needs of users and organization. It obviously does not meet accreditation, licensure, and regulatory requirements, so these issues would have to be addressed. It would probably be more feasible to throw the system out and implement a new system that you purchase from a vendor. The EHR vendors spend millions of dollars on research and development, so they would have a head start. They need to get the proper staff involved to make sure that the system is implemented properly. They also have a tremendous amount of damage control to address. They have to convince the users that an EHR is truly needed and that it can be done properly so that their needs are met.
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 5 Information Technology and Systems 360
References Amatayakul LaTour and Eichenwald-Maki Sayles
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 5 Information Technology and Systems 361
CASE 5-32 Preparation for an Electronic Health Record (EHR) System
An EHR is scheduled for implementation at Tres Rios Hospital in 3 years. The hospital is beginning to conduct the initial planning. They want to ensure that users are prepared for the changes that the EHR will bring to the facility. As you would expect, not all of the staff and medical staff are excited about the implementation of the EHR.
Questions and Suggested Answers These are some examples of what the student may include. 1. What change management issues should be addressed? •
Get user input
•
Identify champion
•
Set expectations
•
Educate staff on process
•
Educate staff on benefits and drawbacks of system
2. What can you do to help prepare the medical staff and employees for the new system? •
Communicate, communicate, communicate
•
Discuss in appropriate meetings
•
Develop newsletters
•
Get as many users as possible involved in systems analysis and implementation
•
Manage expectations
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Section 5 Information Technology and Systems 362
References Amatayakul LaTour and Eichenwald-Maki Sayles
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 5 Information Technology and Systems 363
CASE 5-33 Employee System Access Termination Procedure
Edward, an HIM clerk, was terminated last week. The quality of his work was unacceptable and he was constantly late or absent. Three days after his termination, an audit trail review identified something strange. The information on 100 patients had been deleted from the MPI. It is rare to delete even 1 patient and the deletion of 100 patients was unheard of. Further investigation revealed that someone using Edward’s user name and password had been the person to delete the data. After this incident is turned over to the appropriate authorities for investigation, you turn your attention to ensuring that this situation does not happen again.
Questions and Suggested Answers Write a policy and procedure to discontinue access to the system when an employee is terminated or resigns. Use sound policy and procedure rules and format. Students should utilize proper policy and procedure format. The policy and procedure should address the following: •
Notification of proper staff of employee’s resignation/termination
•
The form to be utilized to document process utilized
•
Providing date and time that employee will no longer be employed at the facility
•
Removing employee from user database immediately upon termination
•
When termination is not at employee’s request, there should be a process in place to expedite the process
•
Monitoring compliance
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Section 5 Information Technology and Systems 364
References Hebda et al. McWay Sayles
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Section 5 Information Technology and Systems 365
CASE 5-34 Intranet Functionality
Your hospital has been discussing the possibility of an intranet for the past year. The Chief Information Officer (CIO) has asked you to create a list of functions that could be included in the intranet. It is to be used as a tool to get the discussions started. The only guidance that he has given you is that the intranet should be useful to staff, management, and the medical staff.
Questions and Suggested Answers 1. Create a list of functions to be provided to the CIO. The student can get creative with this project. Examples of information could include the following: •
Phone directory
•
Medical staff directory
•
Cafeteria menu
•
Cafeteria hours
•
Codes used for cardiac arrest, fire, and so on
•
Policies and procedures
•
Hospital forms
•
Medical record forms
•
Medical staff rules and regulations
•
Human resource benefits
•
Links to corporate and other key websites
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Section 5 Information Technology and Systems 366
2. Write a memo to the CIO describing your recommendations. Students should write a memo using a proper format. The memo should summarize their recommendations and then refer to an attachment that contains the full list.
References Abdelhak et al. Hebda et al. LaTour and Eichenwald-Maki McWay Sayles Sayles and Trawick Tan Wager et al.
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 5 Information Technology and Systems 367
CASE 5-35 Evaluating Systems for Privacy Regulations Compliance
You are the privacy and security officer for your facility; your background is HIM and you are an RHIA with the Certified in Healthcare Privacy and Security (CHPS) credential. You are part of a team that is reviewing the RFPs received from various EHR vendors. Your emphasis in the review will be the privacy and security issues. You know that there are many privacy requirements, some of which are policy related; however, many impact the functionality of information systems. You are in the process of reviewing the RFPs that were returned to you by various EHR vendors. One of the RFPs states that they are HIPAA compliant, so you decide to compare their product to the HIPAA security regulations to determine if this is true.
Questions and Suggested Answers 1. What privacy functions should you look for in the EHR? The student could list many privacy requirements. Some of these include the following: •
Recording access
•
Generating accounting of disclosure
•
Extra protections on psychiatric records
2. What security functions should you look for in the EHR? The student could list many security requirements. Some of these include the following: •
Robust audit control
•
Control access by user
•
Encryption
•
Back-up
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Section 5 Information Technology and Systems 368
3. Is the fact that the vendor claims to be HIPAA compliant adequate for the system you choose? No. ARRA and other laws also apply to privacy and security.
References LaTour and Eichenwald-Maki McWay Quinsey and Brandt Sayles Sayles and Trawick
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 5 Information Technology and Systems 369
CASE 5-36 Website Resources
Your HIM director has asked you to identify 10 Internet websites that could be used by the HIM staff as resources in their jobs.
Questions and Suggested Answers You are to provide the URL address, indicate which staff would find the site useful and how the website can be used. Enter the information you have gathered into Table 5-11. There is virtually an unlimited number of websites that students could select for inclusion. One example is already given in Table 5-11 that is provided for the students. The students need to continue adding resources to the table. Table 5-11 Website Resources Web Resources Name of Website Joint
Which Staff URL
Would Find the Website Useful?
http://www.jointcommis
All HIM staff
Commission sion.org
How the Website Can Be Useful to the HIM Staff This website provides educational materials on the accreditation standards, general information on the Joint Commission and the accreditation. There are also videos and resources for purchase.
© 2014 Cengage Learning ®. All Rights Reserved.
Reference Joint Commission © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 5 Information Technology and Systems 370
CASE 5-37 Voice Recognition Editing
Baja Medical Clinic is a 20-physician multi-disciplinary practice. The clinic has decided to implement a voice recognition system. Approximately 275 patients are seen each day. A vendor has been selected and the system is scheduled to go live in 6 months. Currently the health record is completely paper based. The decision has to be made as to whether front-end or back-end editing should be used.
Questions and Suggested Answers You have been given the responsibility of researching pros and cons of each and making a recommendation. 1. What are the pros and cons of each? Front end: A significant pro is that the reports are ready for use as soon as the physician finishes. Another is that you do not need editors to check the reports. A con is that physicians are taken away from patient care while they are editing the reports. Back end: A con is that you have to hire editors to review the report. There is also a delay from the time the report is completed to when it is edited which slows down access. A pro is that it frees physicians up for patient care. 2. Which do you recommend? Justify your recommendations. Students should select 1 and give a justification for their recommendation. They can use the pros and cons above and other information to support their decision.
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 5 Information Technology and Systems 371
References Sayles Sayles and Trawick
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 5 Information Technology and Systems 372
CASE 5-38 Storage Requirements
The long-term care facility that you work at is implementing an EDMS. The decision has been made to scan the documents at discharge. You discharge an average of 25 patients a month. The average health record averages 750 pages at discharge. You have been given the responsibility of determining the scanner to be used, the number of scanners, the number of CDs needed for longterm storage each year, and the jukebox(s) needed for 1 year of storage. The CDs hold 500 each. Your choices are as follows:
Scanner options Option 1: Scans 50 sheets per minute Option 2: Scans 100 sheets per minute Option 3: Scans 200 sheets per minute
Jukebox options Option 1: Holds 50 CDs Option 2: Holds 250 CDs Option 3: Holds 500 CDs
Questions and Suggested Answers 1. Which scanner(s) do you recommend? The student should make a recommendation of scanner based on the information provided. Different students can choose different scanners so no recommendation is made here.
2. How many scanners would you purchase? This varies based on the scanner purchased. Slower scanners will need more to keep up with the volume load. Students should also consider downtime when making their recommendations.
3. How many CDs will you need for the first year? © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 5 Information Technology and Systems 373
Students should identify the industry standard for size of an average computer file of a scanned document which is 50 KB and then perform calculations to determine the number of CDs.
A megabyte is 1024 KB. Since a CD holds 500 MB each, this equates to 512,000 KB (500*1024). 750 pages per health record × 25 patients per month = 18,750 pages per month. 18,750 pages × 50 KB = 937,500 KB per month 937,500 KB per month × 12 months = 11,250,000 KB per year 11,250,000 KB/512,000 KB per CD = 21.97 = 22 CDs
4. Which jukebox would you recommend? The student can recommend either one.
5. How many jukeboxes will you need for the first 2 years? If the student chooses option 1, 2 years will barely fit. Option 2 will hold a number of years so the student can choose either one.
References Bandwith Calculator. (n.d.) What’s a Byte
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 5 Information Technology and Systems 374
CASE 5-39 Quality Control of Scanning
You are implementing a new EDMS in about a month. As excited as you are about the new system, you are still concerned about the quality of scanned images. You are familiar with other facilities that implemented an imaging system and had serious quality problems. One of the facilities even ended up having to shut down their EDMS due to the problems. You want there to be a firm policy and procedure from the beginning to minimize system clean-up later.
Questions and Suggested Answers 1. What issues would you address in the policy and procedure regarding the quality control process? Examples include the following: •
100% audit
•
Overlapping pages
•
Upside-down pages
•
Contrast issues (too light or too dark)
•
Backs of pages not scanned
•
Process to follow when quality issue is found
•
Wrong target sheets
2. Is there anything else that you can do to help ensure quality in the scanning process? •
Routine maintenance on scanners
•
Strong training program
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 5 Information Technology and Systems 375
•
Barcode forms to reduce indexing errors
•
Use demographic information from the hospital information system
References American Health Information Management Association (AHIMA) LaTour and Eichenwald-Maki Myer and Madamba Sayles and Trawick
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 5 Information Technology and Systems 376
CASE 5-40 Contingency Planning
You work in a facility that was affected by a recent flood. You were more fortunate than most because only your basement was flooded. The problem is that your data center was in the basement. The data on the computers have been completely lost because the computers were destroyed. Unfortunately, the back-up tapes were located in the room next to the data center and were also destroyed. Fortunately, the HIM Department is on the second floor and the charts are intact. Although your lab, radiology, dictated reports, and nursing notes were electronic, the reports had been printed out and filed in the medical record. The HIM director has been trying for a year to get the Information System Department to develop a contingency plan because she wants to stop filing the reports that are stored electronically. The IS staff had not recognized the need for the contingency plan, but the flood was the catalyst that convinced them.
Questions and Suggested Answers 1. What recommendations do you have in order to ensure that your facility will not lose everything if another flood hits the area? Include both contingency and business continuity plans in your recommendations. Students have flexibility with this disaster plan but could include the following: •
Hot or cold back-up site
•
Data backed up at site in another state
•
Mirroring
•
Move data center from basement
•
Manual processes
•
Updating system when it comes up
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Section 5 Information Technology and Systems 377
2. The failure to implement contingency and business continuity plans could result in what types of problems? There are many problems that can be specified. Examples include the following: •
Problems with patient care
•
Data not being entered in system after the system gets back-up
•
Billing not correct
References American Health Information Management Association (AHIMA) Hebda et al. Johns Sayles Sayles and Trawick
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 5 Information Technology and Systems 378
CASE 5-41 Business Continuity Planning
Unfortunately, your facility does not have an EHR yet. In the HIM Department, you have become dependent on computers to function. You still have paper records, but chart requests, disclosure management, transcription, dictation system, chart locator, MPI, and chart deficiencies are all computerized.
Questions and Suggested Answers Write a policy that would outline how your department would operate if one or more of these systems went down for an extended period. The student should use proper policy and procedure format. A business continuity plan for the HIM Department may include many things, including the following: •
Paper chart request forms
•
Bringing in additional staff to cover phones to accept requests for medical records
•
Documenting release of information functions on authorizations and/or log that can be transferred later to the release of information system
•
Microfilmed list of MPI
•
Having forms for physicians to document discharge summary and other normally dictated documents
•
Having word processing software that can be used to transcribe reports
•
Having tape recorders for physicians to use to dictate
•
Periodic printout of chart locations
•
Periodic printout of charts to be completed by each physician
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 5 Information Technology and Systems 379
References Hebda et al. Johns Sayles Sayles and Trawick
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 5 Information Technology and Systems 380
CASE 5-42 Audit Triggers
Since the HIPAA privacy rule was implemented, you have been drowning in your audit trail reviews. You have finally obtained permission from administration to develop and use triggers to help with the review. These triggers, although not eliminating review of the audit trail, can be used to identify potential problems much more quickly and easily than using a manual review. Now that you finally have approval, you have to develop the triggers to be used. Administration wants to review your proposed triggers before they are implemented.
Questions and Suggested Answers Identify 10 triggers that you will present to administration for approval. Students can get creative when writing these triggers. Examples of what the student could come up with are as follows: 1. User last name and patient last name is the same 2. User is looking up patient in area outside of his or her scope of business 3. Patient is a VIP, such as a political figure, actor, or professional athlete 4. Record is accessed after long period of inactivity 5. User attempts multiple unsuccessful log-ins 6. User logs in outside of his or her normal working hours 7. User attempts to access data outside of his or her scope of work 8. User attempts to access his or her spouse or children’s records (assumes this information is available via human resources or other information system) 9. User accesses coworker’s record © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 5 Information Technology and Systems 381
10. User attempts to access record of patient who has requested additional protections on his or her record
References LaTour and Eichenwald-Maki Sayles and Trawick
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 5 Information Technology and Systems 382
CASE 5-43 Password Management
Several managers have reported concerns about how passwords are used in your facility.
Problems reported include the following: •
Passwords are being written down and placed near the computers (e.g., passwords have been taped to the bottom of phones).
•
Passwords are sometimes called across the nursing unit.
•
Users do not log out when leaving a computer. Then someone else sits down and uses the computer with the previous user’s passwords still in place.
You suspect there are other problems with the protection of passwords but you cannot provide them at this time.
Questions and Suggested Answers What password management rules can you put in place to eliminate these problems? Include any other password problems that you suspect but cannot prove. Policies in place could include the following: •
Passwords should not be reused (technology should be able to enforce this).
•
Passwords should be between 6 and 12 characters in length.
•
Passwords should not be shared.
•
Passwords should not be written down.
•
Passwords should include alphanumeric characters.
•
Show that a penalty can be included in the password management rules.
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Section 5 Information Technology and Systems 383
•
Passwords should not be easily guessed, such as spouse’s name, children’s name, pet’s name, or anniversary date.
•
Employee should log out when leaving the terminal.
References Hebda et al. Johns Sayles and Trawick Wager et al.
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 5 Information Technology and Systems 384
CASE 5-44 Electronic Health Record (EHR) Security Plan
You are the Data Security officer for Brownsville Town Hospital. The hospital is preparing to implement an EHR. You have been asked to determine the security measures that your facility will take to maintain confidentiality and prevent loss of data.
Write a security proposal to be presented to the CIO. Areas to be covered include, but are not limited to: •
Physical security of hardware
•
Data security
•
Confidentiality
•
Access
•
Disaster recovery
•
Back-ups
•
Business continuity planning
•
Penalties for violating policies
•
Network security
•
Integrity controls
•
Other
Questions and Suggested Answers This is not a paper—it is a proposal. Write a cover letter to the CIO to introduce the plan and begin the proposal with an executive summary. Figure 5-44A is an example of what the cover letter could look like. Following are notes about what could be included in the executive summary as well as the proposal.
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Section 5 Information Technology and Systems 385
Figure 5-45A Proposal Cover Letter The executive summary should be a summation of the security proposal. It should be about ½ page to 1 page long. The purpose of the executive summary is to provide the Chief Information Officer with enough information to provide a sneak peak at the entire report. For example, some of the recommended physical security measures could be listed. This information and more would be provided again in more detail in the proposal. 1. Physical security of hardware This section of the proposal should include data center protections, like locked doors and either card keys or biometrics. It also should address protections of the hardware throughout the facility, including handheld devices.
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 5 Information Technology and Systems 386
2. Data security This section of the proposal should include virus scanners, spyware protections, daily backups, and cold or hot back-ups. 3. Confidentiality This section should include policy and technical issues. Policies include logging out when leaving the terminal, not sharing passwords, and password protections. Technical issues include controlling who has access to what, audit trails, and encryption. 4. Access Multiple issues should be addressed in this section. It includes the type of access controls used, such as user name/password, biometrics, tokens, and card keys. It should also include what the users can do, such as read, write, delete, and other functions. It should also control what data the user can access. 5. Disaster recovery Issues include hot and cold back-ups. 6. Back-ups Issues to be addressed include frequency of back-ups. 7. Business continuity planning Healthcare facilities have to remain operational even when information systems are down due to hardware, software, or other failure. Students should discuss issues that must be addressed, such as paper forms and updating the system after it is back operational. 8. Penalties for violating policies This should address policies that should be in place. Penalties should be based on the seriousness of the breach and should go up to and including termination. 9. Network security This should address firewalls, encryption, and other network security measures.
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 5 Information Technology and Systems 387
10. Integrity controls This should address malware, intrusion, and other integrity controls. 11. Other This should address any security issue not covered in the materials above. An example of this could be the position of a chief security officer. It could also include audits, monitoring, and training.
References Hebda et al. Johns LaTour and Eichenwald-Maki Quinsey and Brandt Sayles Sayles and Trawick Wager et al.
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 5 Information Technology and Systems 388
CASE 5-45 Electronic Health Record (EHR) Training Plan
The EHR is being implemented in 6 months. Attention has turned to the training plan. Develop a training plan that will ensure that everyone who needs to be trained will be trained in a timely manner. Currently there are 500 employees, 350 of which are clinical staff. Sixty physicians will need to be trained. You currently have access to 2 training classrooms and can get access to another room if needed. The vendor recommends 2 hours of training for nonclinical staff and 4 to 6 hours for clinical staff.
Questions and Suggested Answers Develop a training plan that will ensure that everyone who needs to be trained will be trained in a timely manner. The EHR Training Plan should include the following: 1. Content: You will need several different courses for the different types of users. The courses should be tailored so that an employee is not spending a lot of time learning about functionality that they will never use. •
Example: Clinicians need to know how to enter orders, review clinical information, document clinical information, and review test results.
•
Example: A coder would need to know how to access patient information.
2. Classes for employees: Students should identify the different types of classes that are needed for the various types of staff. 3. A schedule for training: The class time should be round the clock, including weekends, to ensure that sessions are available for all staff regardless of their work schedules. The sessions will need to be short because many hospital employees are not used to sitting for long periods, plus short classes help with scheduling in their work area.
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 5 Information Technology and Systems 389
4. The skills that the trainers need: The students should recognize that the trainers should be super users so they can assist the employees. The trainers also need to be articulate and able to present the information in a logical and meaningful way. 5. Number of classes required: The student will need to do some math and justify their response with data such as the size of the training room. Training rooms will probably only hold 25–30 students at a time. If you assume that all users will need to go through an introductory training session, you would need at least 23 training sessions at 25 students per class. You will probably have to schedule extras, since people go on vacation, are out sick, and so on. If you assume that the 350 clinical users need 1 more training session, this would require 14 more training classes. Physicians may be trained in individual sessions, so this would take 60 sessions, maybe as many as 120 if you want to work with the physicians twice. 6. Amount of time needed for course: Students could give a range with this answer, but the training time should be relatively short for each session. The limit would probably be 2–4 hours. 7. Number of trainers needed: This would be based on the number of classes and whether they are dedicated to the project or teach the classes as part of the job, so students have a lot of flexibility here. They just need to be able to support their response. 8. Format of class (online, lecture, and so on): Classes should be hands-on, with a demonstration by the instructor to start the class. 9. Resources needed: Computer classroom, data projector, training manuals, training database, training environment, instructors, exercises, employee access to training environment after class and before implementation, and competency exam. 10. When you should start training in order to be ready for a December 1 implementation (assume today’s date as July 10)? Again, this will be based on previous information such as the number of classes that need to be taught. The training needs to be close enough to the implementation that the users do not
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Section 5 Information Technology and Systems 390
forget but not so close that they do not have time to practice and get comfortable with the system. 11. When should the training be completed? The training should be completed close to the time of implementation, but students need time to practice after training but before going live. Because of this, training should be finished at least a week or so prior to implementation.
References Amatayakul Hebda et al. LaTour and Eichenwald-Maki Murphy Sayles Sayles and Trawick Wager et al.
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 5 Information Technology and Systems 391
CASE 5-46 Strategic Planning
Bayside General Hospital is in a community that is changing. It had been an industrial city, but many of the industries have closed. The local college is growing and is now the number 1 employer. Other major businesses include healthcare and a local amusement park. The population is also changing. There is a great increase of young people because of the college and work available at the amusement park. A new hospital is opening up in a year. It will be a high-tech facility. The only currently existing hospital competing against you has the trauma center for the area and is opening an OB service. There is no children’s hospital in the area. Both existing hospitals treat some pediatric patients; however, seriously ill pediatric patients are sent to the closest children’s hospital, which is located 2 hours away. Bayside General Hospital has recently added physician offices, home health, and an occupational health center to their network. They have not networked and implemented existing systems to these organizations. Administration developed the following business objectives: •
Improve quality of care provided to patients
•
Use hospital resources effectively and efficiently
•
Increase market share of healthcare services provided within Bayside
Bayside General Hospital has the following information systems implemented: •
Lab information system was implemented 5 years ago
•
Radiology information system was implemented last year
•
Nursing information system was implemented 3 years ago
•
Hospital information system was implemented 10 years ago
•
Decision support system goes live in 6 months
•
Financial information system was implemented 2 years ago
•
Electronic health record
The hospital does not have the following systems: •
Knowledge-based system
•
Order entry/results reporting
•
Intensive care unit
•
Data repository
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 5 Information Technology and Systems 392
Questions and Suggested Answers Based on the information above: 1. How well are systems in place to meet the objectives? The facility does not have the necessary systems in place in order to meet the objectives. Students could justify this statement many ways. Examples include the following: •
Lack of order entry/results reporting to make facility more efficient
•
The decision support system under development could help analyze Bayside’s options
•
Does not have data repository that could centralize data to facilitate data analysis
•
Hospital information is outdated, so may not provide the facility with all of the information needed to measure efficiency
•
A knowledge-based system could help speed up diagnosis and therefore treatment, thus improving the quality of care provided to the patient
2. Determine possible projects to ensure that the objectives are met. Again, the student’s response could vary widely. Possibilities include updating old systems such as the hospital information system. It could also be to add systems that are not in place, according to the case. The students could also identify gaps in the list of systems, such as severity of illness system like APACHE, data warehouse, and the electronic health record. 3. How can you use technology to prepare for the changes in the community? The decision support system that is soon to be implemented can be used to analyze internal and external data. 4. How will HIM be affected by your proposed projects? Again, the answer to this question varies. Many of the recommended systems above directly impact health information management. The use of acuity systems, data warehouses, the electronic health record, the hospital information system, and others are used to collect, store, analyze, and retrieve health information. These projects may require new skills, additional staff, restructuring of the department, education of the hospital staff and medical staff, and looking at data from an enterprise standpoint—not departmental or patient-specific. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 5 Information Technology and Systems 393
References Amatayakul Austin and Boxerman LaTour and Eichenwald-Maki Sayles Sayles and Trawick
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Section 5 Information Technology and Systems 394
CASE 5-47 Single Vendor or Best of Breed
You are HIM director of a 500-bed facility. Two of your HIM systems are outdated, so you’ve decided to update. These systems are the encoder/grouper system and the tumor registry system. You have submitted a capital budget request and received approval to purchase the new systems that you need.
Before you can submit an RFP or even a request for information (RFI), you have a decision to make. You have to decide if you want to purchase systems from your existing vendor, or use the best of breed model. You are considering the pros and cons of each choice of vendors. You want to have the RFP submitted to the vendor(s) in 3 months and you cannot finish writing it until this decision is made.
Questions and Suggested Answers 1. Which would you choose, a single vendor or best of breed? The students could choose either. 2. Why did you choose this model? If the student chooses the single vendor, he or she would give reasons such as ease of implementation, easier maintenance, stronger negotiation, and integrated functionality. If the student chooses the best of breed, then the justification would be the ability to choose the best product for each system. 3. What are the downsides to the model that you selected? If the student chooses single vendor, the downside is that some of the products may be unsatisfactory. If the student chooses best of breed, then the cons are the amount of time to maintain, different log-ins for users, increased training time, and increased number of interfaces. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 5 Information Technology and Systems 395
4. What if you selected a single vendor that has most but not all of the products you need? Will you send the vendor an RFP? All HIM vendors may not have all of the desired products. For example, they may have everything except a tumor registry system. The student could state that the vendor must have all products in order to be eligible for inclusion; they could also state that the vendor can partner with other vendors as long as the main vendor has a certain number of the products. The student can also say that the vendor is eligible as long as they have at least a certain number of vendors.
References Amatayakul Sayles Sayles and Trawick
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Section 5 Information Technology and Systems 396
CASE 5-48 Functional Requirements of a Transcription System
As the transcription supervisor, you have been given the responsibility of developing the functional requirements for a new transcription system that you hope to purchase and install in the next year. You have met with your staff and done some brainstorming to come up with a comprehensive list of functions that you need and whether or not each of the functions is mandatory, desirable, or a luxury. The functional requirements must be comprehensive and include data entry, interfaces, data fields, reporting, and other functionality.
Questions and Suggested Answers Develop the list of functional requirements in the format of Table 5-12. This is an example of what it might look like. Table 5-12 Functional Requirements of a Transcription System Functional Requirements of a Transcription System Function
Mandatory Desirable
Interfaces to existing HIS
X
Interfaces to existing EHR system
X
Contains basic demographic information on each
X
Luxury
patient Requires username and password for log-in
X
Records transcriptionist based on log-in
X
Can design templates for each report type
X
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Section 5 Information Technology and Systems 397
Unlimited number of report types Calculates incentive pay plan based on facilities
X X
requirements Allows automatic faxing of reports to physician office
X
Prints reports on in-house patients automatically to
X
nursing unit Allow view only capability
X
Uses expanders
X
Generates management reports, including lines
X
transcribed by transcriptionist, number of reports transcribed by report type, incentive pay reports Has comprehensive audit trail
X
Biometrics HIPAA compliant
X X
Ability to de-identify reports Data fields include report type, date dictated, date
X X
transcribed (default to today’s date), revised date Workflow technology that allows reports to be sent to
X
supervisor at transcriptionist’s request Tracks quality improvement monitoring Ability to control access and user privileges
X X
© 2014 Cengage Learning ®. All Rights Reserved. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 5 Information Technology and Systems 398
References LaTour and Eichenwald-Maki Sayles and Trawick
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 5 Information Technology and Systems 399
CASE 5-49 Health Information Exchange
Your physicians have asked you to identify the health information exchange (HIE) in your area and to provide the following information about that HIE:
1.
Name of HIE
2.
HIE model used
3.
City where the HIE is located
4.
When the HIE was established
5.
The advantages and disadvantages of participating in the HIE
6.
How the HIE would impact their practice
Questions and Suggested Answers Students should look up their local health information exchange and provide the requested information. The responses will vary by HIE.
References Amatayakul Sayles Sayles and Trawick
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 5 Information Technology and Systems 400
CASE STUDY 5-50 Personal Health Record
You work for Healthcare Insurance. Your organization has decided to provide a PHR to the company’s insured. Your database has claims data, some clinical data, and more. You want the system to go live in 1 year.
Questions and Suggested Answers 1. What issues do you have to address before the go-live date? Many issues can be listed including data quality, patient access, patient submitted data, and data retention. 2. What data should you give patients access to? Students should list specific data to be included which can consist of the following: •
Lab tests
•
Pathology reports
•
Radiology reports
•
Patient instructions
•
Discharge summary
•
Medication lists
References Amatayakul LaTour and Eichenwald-Maki
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 5 Information Technology and Systems 401
McWay Sayles Sayles and Trawick
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Section 5 Information Technology and Systems 402
CASE STUDY 5-51 Public Health
You work for the state department of health. You receive reports of notifiable diseases from healthcare providers around the state. This information is tracked so that you can watch for epidemics and other health hazards. You are purchasing a new population health system to be used for these purposes.
Questions and Suggested Answers What functionality should you look for in the new system? Students should keep in mind the purpose of the system which is tracking and trending notifiable diseases. Students should look for many functions such as the following: •
Data mining
•
Electronic submission by healthcare providers
•
Report writing
•
Graphs
•
Trending
Reference Amatyakul
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Section 5 Information Technology and Systems 403
CASE 5-52 HL7 EHR System Functional Model
You are the CIO of a 300-physician practice. The board of directors has decided to purchase an electronic medical record (EMR).Questions and Suggested Answers You have been asked what the role of the HL7 EHR System Functional Model should have on your decision. 1. Explain the direct care functions of the HL7 EHR System Functional Model. The student can discuss a number of direct care functions and data elements including problem list, medication list, summary list, and much more. 2. Explain the supportive functions of the HL7 EHR System Functional Model. The student can discuss a number of functions required to support healthcare such as directory of physicians, transfer of data to state registries, tracking patients, patient demographics, and much more. 3. Explain the information infrastructure of the HL7 EHR System Functional Model. The student can discuss a number of information infrastructure functions including many different privacy and security measures. 4. Do you recommend that the HL7 EHR System Functional Model should be the basis upon which you evaluate the EMRs? The student should say yes as it is an approved standard. Also, it addresses the basic and advanced functions required for the EMR to be successful.
Reference HL7
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Section 5 Information Technology and Systems 404
CASE 5-53 Data Mining
The facility you work for has grown rapidly and has run out of space. Your administrator is considering constructing a new building. He is considering moving the emergency room to the new building. You have been asked to retrieve some information for him.
Go to the OASIS Web Query Tool, which can be found at http://oasis.state.ga.us/
Questions and Suggested Answers
For the last 5 years, identify the number of ER visits in Georgia, in the North Central Health District, and in Bibb County (or another site specified by your instructor).
1. Trend these data in the appropriate data display. Students should create a graph to display their data. Examples of graphs that are appropriate for trending data are bar graphs and line graphs. Please note that the student will need to select the North Central Health District on the OASIS Web Query Tool in order to see all three geographic areas. 2. What is the trend for the ER services in these 3 geographical areas? The data will vary based on the data and years used. 3. When your administrator asks you for your recommendation on whether or not to continue investigating moving the ER into the new building, what will you say? Again, this will depend on the data. If the number is trending up, then they should continue to investigate the possibility. If the number is trending down or is stagnant, then the space can be better used.
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 5 Information Technology and Systems 405
CASE 5-54 Database Queries
You are an RHIA who is working in the compliance department of a long-term care corporation. You have been asked to create a database to capture data on privacy training efforts. This database will be used to collect data from all of the corporate facilities.
Questions and Suggested Answers Your instructions are as follows:
1. Identify the data elements required. Based on what they have learned, the student should be able to identify a number of data elements that would be needed in tracking training.
2. Build the data dictionary. Students should be able to complete the data dictionary. Based on what they have learned, the students should be able to design the appropriate number of characters, appropriate entries, and so forth for each of the data elements identified in question 1. The data dictionary used should be within the database system.
3. Design a data entry screen that builds data quality into the database. The student should design a data entry screen for the database. In this screen, there should be drop-down boxes, radio buttons, help messages, and other tools that help build data quality into the screen.
4. Design reports. The instructor should give the student guidance on the number of types of reports. Students should use good report design that includes, but is not limited to, the following information on each report: •
Title
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Section 5 Information Technology and Systems 406
•
Date/time
•
Column headings
•
Totals where appropriate
5. Enter 5 training sessions in the database as examples so that you have data to present to the Chief Privacy Officer for approval. The student should use their data entry screen to enter 5 training sessions. They should correct any problems that they find with the data entry screen and the data can be used to run the reports.
Reference Sayles and Trawick
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 5 Information Technology and Systems 407
CASE 5-55 Meaningful Use
You have been asked to consult for a physician who is applying for meaningful use. He works for a small practice with 3 other physicians. One of the other physicians is also applying for meaningful use. The physician plans to apply for Medicare rules. He does not understand the standards and has asked you to help.
Questions and Suggested Answers
1.
Provide the physician with a list of stage 1 and stage 2 standards. The student should access the stage 1 and stage 2 standards from the Center for Medicare and Medicaid Services website. This is a great way to get them used to researching their website.
2.
What would you tell the physician about meaningful use? The student should discuss the requirements, incentive payments, future penalties, due dates, and other requirements of the program.
3.
Is the physician eligible for the meaningful use incentive payments? Yes, the physician is eligible.
Reference Center for Medicare and Medicaid Services
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Section 5 Information Technology and Systems 408
CASE 5-56 Clinical Vocabularies
You have been hearing the subject of clinical vocabularies discussed frequently at several meetings. Since the concept will impact the HIM Department of your ambulatory surgical center, you recognize the need to research the subject more thoroughly to be able to articulate the needs not only of your department, but also of the facility in general.
Questions and Suggested Answers 1. What vocabularies do you have to choose from? Students should list the clinical vocabularies that are appropriate for this setting. They can include both general clinical vocabularies like SNOMED and MEDCIN as well as specialized vocabularies like Nursing Interventions Classification or RxNorm.
2. What are the functions of each of these vocabularies? This answer will vary based on the clinical vocabularies listed. The information provided should include the types of information included, the organization structure, when it is appropriate, and so on.
3. Is the vocabulary appropriate for your setting and purposes? Students should not only answer yes or no but also justify their response.
4. Based on your description, which vocabulary or vocabularies would you choose? Justify your decision. Students should make specific recommendations for the vocabularies to be used. They should provide reasons why they made that particular selection
Reference Giannangelo
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Section 5 Information Technology and Systems 409
References Abdelhak, M., Grostick, S., Hanken, M. A., & Jacobs, E. (Eds.). (2011). Health information: Management of a strategic resource (4th ed.). Philadelphia: W. B. Saunders. Access Patient Flow System (n.d.). Retrieved on September 10, 2012, from http://accessefm.com/Access-Enterprise-Forms-Management-Workflow.aspx Amatayakul, M. (2012). Electronic health records: A practical guide for professionals and organizations (5th ed.). Chicago: American Health Information Management Association. American Health Information Management Association (AHIMA). (2003, October). AHIMA eHIM work group on electronic document management as a component of EHR. Retrieved September 10, 2012, from http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_021594.hcsp?dDocName =bok1_021594 Austin, C. J., & Boxerman, S. B. (2003). Information systems for healthcare management (6th ed.). Chicago: AUPHA Health Administration Press. Bandwith Calculator. Accessed June 18, 2013, at http://easycalculation.com/bandwidthcalculator.php Burke, L., & Weill, B. (2005). Information technology for the health professionals. Upper Saddle River: Pearson Prentice Hall. Center for Medicare and Medicaid Services. (2013). Stage 2. Retrieved May 15, 2013, from http://www.cms.gov/Regulations-andGuidance/Legislation/EHRIncentivePrograms/Stage_2.html Dunn, R. (2006). Quick scan of bar coding. Journal of AHIMA, 77(1), 54–56. Giannangelo, K. (2010). Healthcare code sets, clinical terminologies, and classification systems. Chicago: AHIMA Press. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
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Healthcare Information Management Systems Society. (2003). Implementation guide for the use of bar code technology in healthcare. Retrieved September 10, 2012, from www.himss.org/content/files/implementation_guide.pdf Hebda, T., Czar, P., & Mascar, C. (2005). Handbook of informatics for nurses and health care professionals (3rd ed.). Upper Saddle River: Pearson Prentice Hall. HL7 (2004). HL7 EHR system functional model: A major development towards consensus on electronic health record system functionality – A white paper. Retrieved May 17, 2013, from http://www.hl7.org/documentcenter/public_temp_F9362A3A-1C23-BA170C1F8128BC92E5C0/wg/ehr/EHR-SWhitePaper.pdf Johns, M. (2002). Information management for health professional (2nd ed.). Clifton Park, NY: Thomson Delmar Learning. LaTour, K., & Eichenwald-Maki, S. (2011). Health information management: Concepts, principles and practice (3rd ed.). Chicago: American Health Information Management Association. Mahoney, M. E. (1997). Document imaging and workflow technology in healthcare. Journal of AHIMA, 68(4), 28–36. Murphy, G. F., Hanken, M. A., & Waters, K. A. (1999). Electronic health records: Changing the vision. Philadelphia: W. B. Saunders. Myer, D., & Madamba, R. (2002). Implementing a document imaging system. Journal of AHIMA, 73(9), 44–54. Quinsey, C. A., & Brandt, M. D. (2003). AHIMA practice brief: Information security—an overview. Retrieved November 9, 2006, from http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_022638.hcsp?dDocName =bok1_022638
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 5 Information Technology and Systems 411
Sayles, N. (2013). Health information management technology: An applied approach (4th ed.). Chicago: American Health Information Management Association. Sayles, N., & Trawick, K. (2010). Introduction to computer systems for health information technology. Chicago: American Information Management Association. Tan, J. K. H. (2001). Health management information systems: Methods and practical applications (2nd ed.). Boston: Jones and Bartlett. Wager, K. A., Lee, F. W., & Glaser, J. P. (2005). Managing health care information systems: A practical approach for health care executives. San Francisco: Jossey-Bass. What’s a Byte. Accessed June 18, 2013 from http://www.whatsabyte.com; http://www.whatsabyte.com/P1/byteconverter.htm Williams, A. (2006). Design for better data: How software and users interact onscreen matters to data quality. Journal of AHIMA, 77(2), 56–60.
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SECTION 6 Management and Health Information Services
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Section 6 Management and Health Information Services 413
CASE 6-1 Developing an Organizational Chart for Health Information Management (HIM)
Questions and Suggested Answers Use the list of employees and the classifications in the department provided in Table 6-1 to develop your organizational chart.
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A sample of what the student should produce is shown in Figure 6-1A.
Figure 6-1A Organizational Chart
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Section 6 Management and Health Information Services 414
References Johns LaTour and Eichenwald-Maki Liebler and McConnell
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Section 6 Management and Health Information Services 415
CASE 6-2 Writing a Policy and Procedure Write a policy and procedure for customer service for use by the receptionist at the front desk.
Questions and Suggested Answers A sample of what the student should produce is shown in Figure 6-2A.
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Section 6 Management and Health Information Services 416
PORT BISMARCK HOSPITAL Department Policy
Title
Policy #
Health Information Management
Customer Service through Reception Activities
106.1052
Policy: Good customer service relations will be exhibited through reception activities within the HIM Department. Respond to customer requests in a timely manner and do not allow a customer to walk unattended past the reception area.
Procedure: Good relations will be exhibited to customers through both written and oral communications for walk-in requests, telephone calls, and e-mail messages to both internal and external customers regarding HIM-related activities.
I.
Walk-in Request
Walk-in requests will be received by the HIM receptionist from both internal and external customers. Customer’s request will be responded to appropriately with professional business ethics. Customer request could include and should be directed to:
II. Incomplete Records/Medical Library and Research 1. Notify appropriate HIM staff to pull records or assist physician with research database. 2.
Send healthcare provider to the Doctor’s Dictation Room or the Research Library.
Figure 6-2A Policy and Procedure Form (3 pages)
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Section 6 Management and Health Information Services 417
III. Release of Information (ROI) 1.
Obtain a written request or provide the hospital consent form to be completed for ROI.
2.
Direct requester to sit in reception area.
IV. Staff Meeting 1.
Call to notify HIM staff of customer’s arrival.
2.
Direct customer to wait in the department conference room, if necessary.
V. Vendor Representative 1. Inquire as to request and notify appropriate HIM staff of customer’s arrival. 2. Direct vendor to sit in reception area.
VI. Telephone Calls Practice good telephone etiquette when answering incoming calls, placing callers on hold, transferring calls, and making telephone calls. 1.
Incoming Calls—Answer call by identifying hospital and department, and then greet customer by question “How may I help you?”
2.
Outgoing Calls—Make calls by identifying hospital, department, and self-stating the reason for your call. Have necessary information when placing calls to expedite reason for call (i.e., patient name, date of needed lab report).
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Section 6 Management and Health Information Services 418
Voicemail Messages—Record and maintain a voicemail message, giving department hours of operation and options for how to be forwarded directly to departments within HIM or to leave recording stating request, name, and number to use to return the call. •
Check voicemail messages by 9:30 a.m. each day and appropriately respond to the request in reasonable time.
•
Check for voicemail messages after being away from desk and twice before and twice after lunch.
VII. E-mail Request 1. Check e-mail messages by 10:00 a.m. each day. 2.
Check for e-mail messages twice before and twice after lunch, and reply or follow-up appropriately.
Department Affected: Health Information Management Approved By:
Janet P. Smith, RHIA
Effective Date:
July 15, 20xx
Revised Date:
N/A
References Abdelhak Johns LaTour and Eichenwald-Maki Liebler and McConnell
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3.
Section 6 Management and Health Information Services 419
CASE 6-3 Work Measurement Study
Questions and Suggested Answers 1. Use Table 6-2 to record your work measurement study results. Then use your data to calculate the average time to use in establishing a standard for a person performing the task. Remember to allow for external influences and fatigue when conducting the time study. A work measurement follows on the activity of pulling clinic records in 1-hour increment workstudies. The results reflect that 67 records could be pulled per hour on the average. See the results of the work measurement study report in Table 6-2. The number of charts that could be pulled in an 8-hour shift is projected to be 469, based on the results of the study. 2. Design a productivity report on this task for a person to log and report weekly production to the supervisor. The second part of this case requires students to develop a productivity report on the particular task on which they performed their work measurement study. Find a sample productivity report on the sample work measurement given for pulling records. The requirement of having staff report productivity on their job task can be used as a quality control method to establish internal standards and benchmark activities against best practices of other similar facilities or professional standards for the task. A sample productivity report is presented in Table 6-3A.
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Section 6 Management and Health Information Services 420
Table 6-2 Work Measurement Study Form
WORK MEASUREMENT STUDY Pull Clinic Records ____9-23-xx___ Times Task Was Studied
Amount Completed
Time 1
Start 2:15 Stop 3:15
70
Time 2
Start 2:00 Stop 3:00
74
Time 3
Start 2:10 Stop 3:10
68
Time 4
Start 1:45 Stop 2:45
72
Time 5
Start 2:00 Stop 3:00
62
Time 6
Start 2:15 Stop 3:15
55
Total Amount Completed Average Productivity Productivity Expected per 8-hour Day
401 401 (Total)/6 = 66.5 = 67 per hour 67 7 = 469
Comments/Calculations: Work measurement shows that 469 clinic records could be pulled by 1 employee in an 8-hour workday, allowing a 30-minute lunch and 2 15-minute breaks during the work shift. © 2014 Cengage Learning ®. All Rights Reserved.
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Section 6 Management and Health Information Services 421
Table 6-3A Monthly Productivity Report
Monthly Productivity Report Pulling Clinic Records Instructions: Record totals daily on the number of clinic records pulled for the work shift. Week Date Begin/End
Monday
Tuesday
Wednesday
Thursday
Friday
Comments: Note the number of hours worked for any particular day, if workday is less than an 8-hour shift. © 2014 Cengage Learning ®. All Rights Reserved.
References Abdelhak Johns LaTour and Eichenwald-Maki Liebler and McConnell © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 6 Management and Health Information Services 422
CASE 6-4 Evaluating Employees’ Skills
Questions and Suggested Answers 1. Which organizational agencies should be considered in determining what competency standards should be established? • The Centers for Medicare and Medicaid Services (CMS) • Joint Commission • Occupational Safety Healthcare Act (OSHA) • American Health Information Management Association (AHIMA) • Federal Legislation for Health Insurance Portability and Accountability Act (HIPAA) requirements • Individual state laws • Healthcare facilities and/or corporate policies and procedures and competencies standards 2. Identify elements that should be met to remain competent. The effective management of staff and services requires that attention be given in the area of staff development. You could divide the development of an employee competency form into 3 major areas to include the following: • Hospital orientation • Departmental orientation • Job-specific training/continuing education The management of maintaining accurate employee competency records would require the employee to report any participation in training and staff development through the HI manager, in order to update the competency record on an ongoing basis. To list the required elements, give consideration to the following: • Governmental regulations through the CMS, especially in the area of coding compliance for reimbursement purposes • Joint Commission standards that require competency of staff • The Occupational Safety Healthcare Act (OSHA), federal legislation that requires adoption of safety and health guidelines that are established and should be followed by staff Adhering to safety policies in regard to lifting First-aid measures Responding appropriately to toxic spills of products used in the work setting referencing OSHA required Material Safety Data Sheet (MSDS) The American Health Information Management Association (AHIMA) requires • Adopting a professional code of ethics • Use of various guidelines and practices such as • Standardizing collection and transmittal of electronic data • Coding rules and guidelines for staff to be competent in work practice © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 6 Management and Health Information Services 423
•
• •
• • •
• • • • • • •
Continued education requirements to maintain professional credentials The federal law that requires compliance through HIPAA legislation to establish a privacy and security officer to oversee privacy and security of patient’s protected health information (PHI) in records and systems throughout the healthcare organizations Individual state laws that establish competency requirements in HI staff Individual healthcare facilities and/or corporations that require competency in staff to carry out the bylaws, rules, policies, and procedures of the organization Competency elements relative to the healthcare facilities human resource activities for HI staff include: fire safety training requirements (i.e., RACE), infection control training (i.e., hand washing and universal protocol), disaster preparedness, hospital compliance program, and training on the organization’s mission and vision statements Training on first-aid issues Patient confidentiality in respect to privacy and security of protected health information (PHI)\Employee benefits (i.e., clocking procedure) The hospital quality improvement (QI) program Competency requirements that must be met even within the HIM Department, including the following orientation activities The department’s compliance program Workflow through department Department chain of command through organizational chart Policy and Procedure Manual Material Safety Data Sheet Manual Departmental QI program Equipment and system training of telephone, master patient index (MPI), copier, fax machine Professional development through attendance of continuing education programs at local, state, and national levels and the availability of e-training alternatives and opportunities There is a sample orientation checklist shown in Health Information Management Concepts, Principles, and Practice (3rd ed.) on page 744. Visit AHIMA’s website to see the online CEU reporting form. A sample report form for continuing education and staff development to be completed by the employee is shown in Figure 6-4A.
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Section 6 Management and Health Information Services 424
Figure 6-4A Continuing Education and Development Reporting Form
References American Health Information Management Association (AHIMA) (n.d.). Johns LaTour and Eichenwald-Maki Liebler and McConnell McWay
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Section 6 Management and Health Information Services 425
CASE 6-5 Recruiting Resources
Questions and Suggested Answers 1. How should you proceed? Consider the departmental budget allowed for recruitment and decide if you will continue to advertise in the Herald Tribune or if other advertisement media might produce better candidates. 2. What are your options? •
Review the advertisement placed in the paper and the job description eligibility requirements to ascertain if coding experience is listed. Specifications to consider may include a required amount of coding experience, a coding certification from a renowned organization, and/or a college degree from an accredited health information program with intent to write and pass the national exam.
•
A matrix table may be established, with measurable weights assigned to established interview questions, to use and rank each candidate you interview for the position. Screen the applications and interview the top 3 candidates received from the pool of applications received. Total the interview weights of each candidate interviewed from the established matrix table. Rank the candidates to see who scored the highest based on established criteria for the job. Since the recruitment did not seem to bring in qualified applicants, consider developing a heavily weighted interview question on the candidate’s willingness to attend required paid training in coding courses (i.e., AHIMA e-training or a coding certification program) through the healthcare organization.
•
Since recruitment did not generate qualified applicants and training a coder may be an option, consider promoting from within the organization with the same stipulation to attend paid training in coding courses (i.e., AHIMA e-training or a coding certification program) through the healthcare organization. However, do not forget to consider the consequences of the vacancy a promotion is going to create within another position.
•
Outsource with contract coders for a period of time until qualified candidates apply for the position or ample time is allowed to adequately train staff in coding proficiency.
•
Advertise to other media sources to see if qualified candidates are attracted. Other direct recruiting sources may be through the following: a. Health information trade papers or journals (i.e., Journal of AHIMA, Advance, and For the Record) b. Personalized mailing to health information students or known credentialed professionals at their school or home c. Online recruiting (i.e., AHIMA website or healthcare facilities’ websites) d. Professional meetings and conferences (notification of job openings through postings on a communications board or making announcements in the meetings)
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Section 6 Management and Health Information Services 426
e. Review of unsolicited applications (i.e., human resources [HR] application file) or resumes (i.e., Internet job banks) •
Consider incentive programs to recruit qualified candidates through staff incentives that include bonus pay to current employees who recruit new employees; or education grants, scholarships, or tuition reimbursement programs to help finance staff development of positions through formal educational programs.
•
Contract with a professional recruiting service.
3. Which would you pick and why? This would depend on the student’s responses and justification.
References Johns LaTour and Eichenwald-Maki Liebler and McConnell McWay
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Section 6 Management and Health Information Services 427
CASE 6-6 Recruitment Advertisement
Questions and Suggested Answers What should you do? Meet with the HR director to discuss the advertisement and explain that the coding position was listed erroneously in the newspaper and needs to be rewritten and submitted to recruit qualified applicants. The advertisement needs to be corrected so that it does not mislead other applicants for the position. The applicants who have already applied should be contacted as soon as possible to explain what happened with the advertisement and of the required qualifications for the position. These applicants should be encouraged to reapply for the position if their qualifications meet the eligibility requirements. If they do not qualify for the coding position, assure them that their application will kept in the pool for further consideration when a position that they may qualify for becomes available. You and the HR director should review the advertisement placed in the paper and the job description eligibility requirements to ascertain if coding experience is listed. Specifications to consider may include a required amount of coding experience, a coding certification from an appropriate, recognized organization, and/or a college degree from an accredited health information program with intent to write and pass the national exam. Work with the HR director to write an advertisement that describes the position, education, and experience requirements more specifically. The facility will need to post the position with the new information to recruit qualified applicants.
References Johns LaTour and Eichenwald-Maki Liebler and McConnell McWay
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Section 6 Management and Health Information Services 428
CASE 6-7 Interviewing Job Applicants
Questions and Suggested Answers Have the students pick a scenario and assume the roles of the applicant and the interviewer. Then have them present a role-play of the scenario to the class. Have the class critique each role-play portrayed by their classmates to identify compliance or noncompliance with employment laws. Because there are any number of variations that could occur with the cases, the instructor should be able to use the student’s critiques to reinforce proper interviewing techniques and identify compliance and noncompliance with employment laws.
References Johns LaTour and Eichenwald-Maki Liebler and McConnell McWay
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Section 6 Management and Health Information Services 429
CASE 6-8 Job Applicant and the Americans with Disabilities Act (ADA)
Questions and Suggested Answers 1. How should you proceed? The candidates appearing to have equal qualifications should be scheduled to come in for an individual interview with you. Establish an organized process to evaluate each candidate on the same criteria and questions posed. A matrix table may be established, with measurable weights assigned to established interview questions, to use and rank each candidate you interview for the position. Interview questions may regard the candidate’s experience, background, training, and education within the field. The candidate could be invited to inquire about the job skills and technical skills required or to discuss his or her career goals and the opportunities for advancement within the facility. You could take this opportunity to give any required testing or to provide interview scenario cases to gauge the candidate’s response in a given situation. Also, you could allow opportunity to answer any further questions the candidate may have. 2. How would you determine who gets the position? •
If a weighted matrix table is used for the interview process, then total the interview weights of each candidate. Rank the candidates to see who scored the highest based on established criteria for the job. This would make the selection based upon measurable criteria.
•
It would be advisable to schedule a meeting with the HR director and discuss the status of the recruitment, interview, and selection processes. The HR director serves in an advisory line staff position to share his or her expertise regarding labor laws and to give advice on your recruitment process and interviews with the candidates. There should be communications with the HR director and the candidates should be evaluated equally in the selection process.
•
If a weighted matrix table based on established criteria was used, share the processes and outcomes with the HR director at the meeting. Discuss the outcomes from each interview and acknowledge compliance to the Americans with Disabilities Act of 1990 (ADA) and related federal labor laws that allow for reasonable accommodations for eligible candidates. The HR director can offer insight into the labor laws and ADA and provide advice to department managers on the rights of candidates. It may be advisable for you to include the HR director in a follow-up interview with a candidate with disabilities. The position, the shift requirements, and the hospital benefits can be discussed further. The candidate will have the opportunity to ask any unanswered questions, and you can inquire if there would be any reason he or she could not meet the job requirements. If the candidate with disabilities is the selected applicant, it is required by federal law that he or she be given equal access to the organization’s services and facilities. If for any reason it is determined that any part of the position, services, or facilities needs changes to be made to meet reasonable accommodations, it is the organization’s responsibility to make the necessary changes before the candidate begins employment.
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Section 6 Management and Health Information Services 430
References Davis and Marion Johns LaTour and Eichenwald-Maki Liebler and McConnell McWay
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Section 6 Management and Health Information Services 431
CASE 6-9 Developing a Training Plan
Questions and Suggested Answers 1. Develop a training plan. The manager should develop a plan to identify where the training needs of the department exist. This plan may include the following: • Review of job descriptions and specified job requirements and technical skills. • Review of employee’s past performance ratings to identify weaknesses or trends in any technical aspects of his or her job. • Review of personnel records and any disciplinary measures written up to identify trends. •
Analysis of departmental short- and long-term goals to determine if any new equipment or skill sets will be required of the staff. • Strategic planning of any external factors that may require new skills, which may include regulatory requirements or standards, new laws, new standards, and new technologies. 2. Include the specific topics to be covered, the amount of time that you plan to devote to training for each group, and how you will cover their responsibilities during the training. After identifying training needs, establish goals and objectives of your training program with quantifiable, measurable terms. The resources necessary to implement the training program must be determined, because some training may be met within the department through mentoring, job rotation, or role-playing, while other training aspects may require attendance of in-house training programs or e-HIM training through Internet resources. Still other aspects may require travel to seminars, conferences, or a formal education program. The training program should be outlined in a time schedule, and perhaps more easily managed utilizing a Gantt chart. 3. How do you prioritize who receives training first and what type of training is conducted first? This is a performance improvement (PI) project to improve services in various areas and services within the department. The prioritization of who receives training first can be identified by those functional areas having the most impact on customer outcomes. This approach easily equates to a methodology developed by the Joint Commission for high-risk tasks. The Joint Commission prioritizes PI projects or opportunities for improvement by selecting those having high risk, high volume, or high cost to the work unit or organization.
References AHIMA Advantage 7:8 (December 2003) (n.d.)
Duggan Johns LaTour and Eichenwald-Maki Liebler and McConnell McWay © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 6 Management and Health Information Services 432
CASE 6-10 Department Coverage
Questions and Suggested Answers 1. What are your options? You have different options you can consider to improve customer service. Review the process and staffing needs. Use the PDSA (Plan, Do, Study, and Act) cycle. •
Follow up on the functionality of the phone to see if call forwarding is allowed and, if so, whether the staff are using the function under circumstances when someone is out.
•
Perhaps the department receptionist could be given the capability and responsibility of having phones forwarded to her when any staff member is out. • If the receptionist is out, the responsibility could be given to an employee with a different job role to assume the duty of transferring the receptionist’s calls to him- or herself. 2. What would you recommend and why? This will depend upon each student’s chosen option and justification.
Reference LaTour and Eichenwald-Maki
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Section 6 Management and Health Information Services 433
CASE 6-11 Decision Making
Questions and Suggested Answers How should the director choose which employee will go? It is important to show the new employee that the organization supports continued education. Effective leadership is exemplified through managers who empower their employees with necessary tools, resources, and training. The goal is to enable them to use these skills and knowledge to solve problems and contribute ideas to benefit the department or work unit. The director could choose to meet with each of the employees individually or together; but she should explain she wished she could send both of them together. However, the budget and staffing can support only one of them attending the AHIMA national conference. She should directly follow up that she has approved for the new employee to attend the conference and that her training request should be submitted within the week for administrative approval. The longer tenure employee’s continuing education needs could be met through alternative means this year by attending a reasonable local or state conference or seminar.
References AHIMA Advantage 7:7 (October 2003)
Johns LaTour and Eichenwald-Maki Liebler and McConnell McWay
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Section 6 Management and Health Information Services 434
CASE 6-12 Progressive Disciplinary Approach
Questions and Suggested Answers How would you handle the following situations if you were an effective HIM Manager who practices progressive discipline measures? Disciplinary Situation 1 How would you discuss this with Jean and what would be your next step? The situation calls for a suspension from work to be given in the progressive disciplinary steps. You could ask her to meet with you toward the end of her work shift, at which time you could explain that her reporting to work had shown no improvement since your last counseling session. You can remind her that you have talked numerous times regarding the same problem, which had extended to the point of receiving a written warning regarding her tardiness when the two of you last talked. Explain that her repeated offense leaves you no alternative but to suspend her from work for 3 days without pay. Ask her what she could do to prevent the problem from recurring. Allow her a moment to reflect on and respond to measures she could take to eliminate the problem. Tell her that she should use the 3 days to determine how she can rearrange her mornings to allow her to make it to work on time in the future. Ask her to sign and date this documented counseling session, reflecting her 3 days of suspension and date to return to work. Disciplinary Situation 2 How would you discuss this with Carla and what would be your next step? The situation calls for a written warning session to be given in the progressive disciplinary steps. Gather the proper documentation, perhaps including past audits, that reflect decline of Carla’s work performance. If Carla works in a position of coding where she might benefit from additional training, gather specifics on the earliest upcoming workshop and check if your education/training budget could afford to send her. Speak with Carla early in the day and ask her if she could plan to meet briefly with you later, after lunch. When she comes to your office, ask her to sit and share with you how her work is going. Ask her if there are any problems distracting her at work. If any personal problems are revealed from which she may benefit with further counseling through the Employee Assistance Program, you should suggest the services and give her the contact information. Show her the downward trend in the quality and/or production of her work that recent audits reflect, and inform her of your expectations and standards. Tell her that you expect her work to improve and that you will reevaluate her performance in a few weeks. Give her the registration form of the upcoming workshop and ask her to complete it and send it back to you by the end of the week, so you can review it and approve for her to attend. Ask her if she has any questions about this meeting. If she does not have any questions, ask her to read and sign a note stating that the two of you met and discussed the problem, that expectations of her work performance were discussed, and plans (if appropriate for her position) are being made for her to attend a workshop for further training in her position.
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Section 6 Management and Health Information Services 435
Disciplinary Situation 3 Discuss this with Susan. How would you handle the situation? This situation calls for a verbal counseling session to be held with Susan in the progressive disciplinary steps. Since this is the first occurrence of Susan responding in an unprofessional manner to a customer and it is unusual behavior for her, ask her to meet briefly with you to share what the requestor wanted. After listening to her response, show empathy for her apparent frustration and “bad day,” but express to her the importance of always being professional to the customers. If the customer becomes irrational and Susan feels her patience becoming short, suggest that she respond by saying that she will have to check further into the situation and get back with him or her. She should bring the issue to her direct supervisor and ask for input on the situation. Impress upon her that she should never allow herself to reach the point you witnessed and heard this morning with the requestor. After Susan leaves your office, document that you held a counseling session on customer relations and advised her in your verbal counseling session. Be sure to sign and date your documented counseling session and file in her personnel file. Disciplinary Situation 4 How would you discuss the situation with Pam? The situation calls for a verbal counseling session to be held with Pam in the progressive disciplinary steps. Tell Pam that you would like to speak with her in your office. When she comes into your office, have her sit with you and share how her job is going. Keep all discussions centered on “performance” and acknowledge that you have noticed her on the phone more than usual over the recent past. You may share that phone logs are available per phone extension to reflect incoming and outgoing calls, and may be accessed for review if it were to become necessary. Express the importance of maintaining work standards and that excessive phone interruptions and conversations can be distractions that impact productivity and affect her work quality. You may acknowledge that if personal problems are brought to work they can negatively impact not only her work but also the work environment among coworkers. Share with her that if she needs assistance through counseling, the Employee Assistance Program is offered as an employee benefit to help employees through difficult times. Tell her that you expect the phone calls to be minimized and more concentrated efforts put toward her work. Document that you held a counseling session with Pam on excessive phone conversations during work and advised her in your verbal counseling session. Be sure to sign and date your documented counseling session and file in her personnel file. Disciplinary Situation 5 Discuss this situation with them. What would you bring out in your meeting with them? The situation calls for a suspension from work without pay in the progressive disciplinary steps. An effective manager should exercise conflict resolution in this situation. Either of the 2 main approaches can be taken when conflicts occur. The manager may choose to escalate or suppress (not address) the situation. However, in this particular situation the progressive disciplinary steps began in the past with these 2 employees when a previous conflict occurred between them. At that time, they were informed of future disciplinary actions should it occur again. Therefore, you should take the next disciplinary step. Regardless of “who did what,” a 3-day suspension is the next step. A manager must note that to purposely avoid or suppress conflict will likely allow the unresolved problem to build up anger and later explode even more forcefully. The manager © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 6 Management and Health Information Services 436
should meet with the employees to give them their 3-day suspension without pay, but first decide what counseling strategy should be given to the situation. • If the manager wanted to be more suppressive to the situation, she could counsel them separately and give them their suspension notice. • The other option is for the manager to counsel the employees together, requiring that they find a mutually acceptable solution of work camaraderie and professionalism upon their return to work. The manager could require that a discussion take place between the 2 employees by 1. Compromise—allowing them to find a compromise by requiring each party to develop a solution on how they will get along in the future; 2. Control—allowing you to control the discussion session by requiring tempers and emotions to cool off, to first establish rules on how they conduct their discussion (i.e., allowing each to present issues that they disagree on one at a time interchangeably); and 3. Constructive confrontation—allowing constructive confrontation from your involvement and advice in their discussion presented, and allowing you to contribute suggestions on how they can resolve their issues. Have the employees sign and date the 3-day suspension notice to place in their personnel files. Disciplinary Situation 6 How would you discuss the situation with Kim? Feedback on employee progress should be given quite frequently during the probationary period, which usually is the first 90 days of employment, as outlined in the hospital’s HR policy and procedures. The probationary period is a time for a new employee to decide if he or she likes the job and for the organization to determine if the new employee is able to meet its requirements. It is important that you give feedback to a new employee throughout the probationary period, allowing the employee the opportunity to improve his or her performance. Usually, the organization can terminate employment due to inability to perform the job at the conclusion of the probationary period. It would certainly be unfair to employees to be terminated after the probationary period if they had no idea of the unsatisfactory nature of their work or had no opportunity to rectify deficiencies in meeting the job requirements. Be sure to document feedback (i.e., concerning required standards) given throughout the probationary period to Kim during her training. At the conclusion of her probationary period, a probationary evaluation is to be conducted with Kim to decide if continued employment is going to be given or whether termination is inevitable. The documented verbal feedback given to her during her probationary period can be used as a tool to decide if improvement has been made. The formal probationary evaluation is signed by the employee and is to be made part of the personnel file reflecting employment or termination. Disciplinary Situation 7 How would you discuss the situation with Kelly? The situation calls for a verbal counseling session in the progressive disciplinary steps. An effective manager should exercise conflict resolution in this situation. Either of the 2 main approaches can be taken when conflicts occur. •
The manager may choose to escalate or suppress (not address) the situation. A manager must note that to purposely avoid or suppress conflict would likely allow the problem to build anger between the coding employee and her supervisor, and escalate into an even bigger problem later. Also, to avoid the situation would send the wrong message to your other managers and staff, bringing morale down within the department.
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Section 6 Management and Health Information Services 437
•
The manager may choose to confront the employee. The HIM manager should call her coding supervisor, Kelly, into the office and ask her how her work unit is doing. This will allow Kelly the opportunity to admit her wrongdoing and the occurrence that happened between her and her coder. If she does not mention the occurrence, inquire whether she had a confrontation with a coding employee recently. If she still does not confide, be more direct and tell her that apparently an unprofessional encounter occurred between her and an employee and ask her to tell you about it.
Ask Kelly what was said and make suggestions on how it might have been handled differently. Let Kelly know that being in a managerial position in the future requires display of professionalism toward her subordinates and coworkers. Let her know that any recurrence of unprofessional management skills could result in further disciplinary action. Discuss sending her to a management workshop to improve her managerial skills. After meeting with Kelly, document the verbal counseling session, the suggestion of a management workshop, and the advice given to her and file it in her personnel record.
References AHIMA Advantage 7:7 (October 2003)
Johns LaTour and Eichenwald-Maki Liebler and McConnell McConnell Squazzo
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Section 6 Management and Health Information Services 438
CASE 6-13 Falsification of Information on Employment Application
Questions and Suggested Answers 1. What should Jeremy do? Schedule a meeting with the HR Department and bring a copy of the job description and eligibility requirements of the transcription position. Review the requirements to acknowledge if an associate degree was a requirement in the job description at the time Laura was hired. Share the information he had obtained about the employee with the HR director and inquire whether an alternative disciplinary action exists, if he desires to keep her in the position. 2. How should he handle the meeting with Laura? The HIM director should obtain copies of the hospital application, HR policy regarding infraction for falsification of employment application, and the employee’s completed application when she applied for the position. The HIM director may elect to have an HR staff person attend the counseling session he holds with the employee. The HIM director could open the meeting after introductions by saying he has some concerns that need to be acknowledged and clarified. The director should give the application to Laura and ask her if she could look through the employment application she completed and verify that everything is true. If Laura continues to say that everything is true, then the director will have to confront his employee on the matter of interest. If there continues to be disagreement, the director could ask Laura how the college could not acknowledge her earned degree upon inquiry with the registrar’s office. A final confirmation could be to require that Laura bring a copy of her college degree to him by the end of the week. On the contrary, if Laura admits to the error that she reported having an associate degree on her application, ask why she did. The HR staff may desire to share with her the seriousness of falsifying employment applications and the infraction of automatic termination for doing so. In further discussion it can be brought to her attention that a statement exists on the job application where candidates consent to everything entered on the application being true. This statement is authenticated by the applicant’s signature at time of completing the application process. Show her on her application where she signed that statement. The conclusion of the counseling session and infraction implicated to Laura will be based upon the discussions held previously between the HIM director and the HR director about the employee situation. •
If the HR director allows the HIM director to retain the employee, the next most severe infraction should be incurred. Under progressive disciplinary measures, Laura should be given 3-day suspension without pay and be asked to sign her disciplinary form with the measures that will be applied. If a suspension is enforced, she should sign her counseling sheet and ask to not return to work for the next 3 business days.
•
If she is terminated from employment, termination papers may be handed to her at that time.
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Section 6 Management and Health Information Services 439
References Johns LaTour and Eichenwald-Maki Liebler and McConnell Squazzo
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 6 Management and Health Information Services 440
CASE 6-14 Time Management
Questions and Suggested Answers 1. Might an alternative means be available that you could consider (other than hiring a replacement full-time employee [FTE]) in providing ROI service? If so, what? • The alternative of outsourcing the ROI service could be an option instead of hiring an FTE to place in the open position. Several ROI companies exist that specialize in the legalities of privacy and confidentiality of protected health information (PHI). Of course, hospital compliance issues must be addressed in obtaining a signed business associate agreement to outsource the services. • Another option may be to have current employees rotate the job, relative to a job-share type arrangement, until a permanent FTE can be hired and trained. This would help keep the ROI services from creating a large backlog until a permanent FTE can be hired to fill the position, and not place too much of a burden on any one staff member. However, realize that various staff positions may fall behind in productivity a little during this job-share period. This option should be only for a short-term arrangement, preferably less than 2 months. • The option to hire temporary staff could be considered, but may not be advisable. The expertise needed in compliance with HIPAA legislation, state laws, hospital policies and procedures, and hospital orientation would require extensive training for temporary staffing. This would only be a quick fix and could set the hospital up to high risk in compliance with PHI. 2. How should you respond to the business office manager? Schedule a meeting with the business office manager and bring a management report summarizing how many pending requests were received before the ROI position became vacant and how many were received after the ROI position became vacant. Share your new approval received to fill the position and your plan to resume the ROI services soon. In the meantime, request the business office manager to identify the most critical requests to be completed that will have the largest impact on improving accounts receivable days (AR Days). You can assure her that these will get priority attention on turnaround. 3. What elements do you feel should be included in the report for administration? • Compose a management report reflecting the total number of pending requests. • Reflect a breakdown on what type of requestors make up the total number of requests pending. • If financial management reports are accessible, report how much accounts receivable is pending due to backlogged requests. • Report how many average requests are received each weekday. • Provide standards on what is the average production of processing requests. • Provide a plan of how long it would take to eliminate the backlog once an experienced ROI coordinator or contract service is hired. 4. How should you respond to the coder? Tell your coder that you are sorry, but you will have to reschedule a meeting later, since you have an important report due in just 2 hours. Assure her that you are interested in hearing what she has to say, but that it will have to wait until you have completed this project. Tell her that when the report is turned in you will call her to schedule a meeting at a convenient time for her. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 6 Management and Health Information Services 441
References Cleverley and Cameron Johns LaTour and Eichenwald-Maki Libeler and McConnell McWay
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Section 6 Management and Health Information Services 442
CASE 6-15 Interdepartmental Communications
Questions and Suggested Answers 1. How should Mr. Rheems respond to the operating room (OR) regarding Dr. Jenkins’ history and physical (H&P) report? Mr. Rheems should tell the OR supervisor that the system was searched again upon request, and it was noted that the H&P had just been dictated by the surgeon at 8:15 a.m. that day. He should further explain that after reviewing the surgical schedule for the day, he realized this had been dictated just 1 hour prior to the scheduled case. Mr. Rheems should explain that the transcription supervisor checked the system the afternoon before and the dictation was not there, but upon the request this morning discovered that Dr. Jenkins had just dictated and it is being typed at this time. He can further clarify that the H&P was not designated as a STAT dictation by Dr. Jenkins through the dictation system functionality, but if he had, the transcriptionist would have picked it up in the system queue to type STAT and it would already be in the OR on the chart. Mr. Rheems should tell the OR supervisor that he was concerned that the patient was able to be prepped and cleared for anesthesia without the H&P being on the patient record at time the nurse completed her OR checklist. 2. Should this individual incident be taken to administrative staff? If so, to whom? Yes. Because the transcription supervisor informed you that this has happened other times over the past few months, it would be advisable to have the chief operations officer or an administrative medical staff liaison be made aware of the incidents. 3. Should this individual incident be taken to a medical staff committee? If so, which committee? If not, what actions should Mr. Rheems take to prevent recurrence of such activity against the HIM Department in the future? Mr. Rheems should meet with the hospital QI director to share the incident that recently occurred and suggest performing a baseline study on missing H&Ps prior to surgery over the next quarter. If the QI director agrees to approve the study for the next quarter, a meeting could be scheduled with the OR supervisor to discuss the intradepartmental study and suggest team members to participate in the QI study. Mr. Rheems could suggest that the goal of the study is to determine why H&P reports are not completed in a timely manner for surgical patients.
References Johns LaTour and Eichenwald-Maki Liebler and McConnell McCuen et al.
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Section 6 Management and Health Information Services 443
CASE 6-16 Merit Raise
Questions and Suggested Answers How might you seek an increase in pay from your current employer that is a more comparable salary to the market scale for RHIA inpatient coders? Different sources can be researched for the most current salary information on the health information profession. The Internet may be used to search for salary information; however, the sources for research data found on the Internet should be verified. The AHIMA conducts work salary surveys on a periodic basis. It can be accessed through the Journal of AHIMA or through e-HIM sources of Practice Brief articles. The AHIMA survey information most often provides specific salary averages by credential level, state, years of experience, and job role or position.
References Johns Liebler and McConnell McConnell
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Section 6 Management and Health Information Services 444
CASE 6-17 Incentive-Based Compensation Programs
Questions and Suggested Answers Review each program and complete the computation of incentive pay based upon the payment scale given for each program. Incentive-Based Compensation Program 1 The incentive pay is $1.00 per dictated minute transcribed. Table 6-3 Transcriptionist Incentive-Based Pay: Program 1 Transcriptionist Incentive-Based Pay: Program 1
Number of Hours Worked
Number of Minutes Transcribed
Minimum Required Biweekly Production
Amount of Incentive Pay
Jeana
80
1,145
1,200
$1,145.00
Meagan
80
1,200
1,200
$1,200.00
Sandra
80
1,264
1,200
$1,264.00
Julia
80
1,320
1,200
$1,200.00
Tenille
80
1,410
1,200
$1,410.00
Transcriptionist
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Section 6 Management and Health Information Services 445
Incentive-Based Compensation Program 2 The incentive pay is $0.15 per line transcribed based upon 65 characters per line. Table 6-4 Transcriptionist Incentive-Based Pay: Program 2 Transcriptionist Incentive-Based Pay: Program 2 Transcriptionist
Number of Hours Worked
Number of Lines Transcribed
Minimum Required Biweekly Production
Amount of Incentive Pay
Jeana
80
7,400
8,200
$1,100.00
Meagan
80
8,010
8,200
$1,201.50
Sandra
80
8,215
8,200
$1,232.25
Julia
80
8,575
8,200
$1,286.25
Tenille
80
8,885
8,200
$1,332.75
© 2014 Cengage Learning ®. All Rights Reserved.
Incentive-Based Compensation Program 3 The incentive pay per dictated minute, over the required 600 minutes, is $1.00. You are given the daily production in Table 6-5. Calculate the weekly incentive pay for each transcriptionist using Table 6-6. Table 6-5 Weekly Transcription Totals for Incentive-Based Pay: Program 3 Weekly Transcription Totals for Inventive-Based Pay: Program 3 Transcriptionist
Monday Minutes
Tuesday Minutes
Wednesday Minutes
Thursday Minutes
Friday Minutes
Total Minutes
Jeana
90
90
90
90
90
450
Meagan
90
90
89
95
122
486
Sandra
112
110
124
98
106
550
Julia
105
123
145
107
131
611
Tenille
157
132
137
123
116
665
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Section 6 Management and Health Information Services 446
Table 6-6 Transcriptionist Incentive-Based Pay: Program 3 Transcriptionist Incentive-Based Pay: Program 3 Transcriptionist
Total Hours Worked
Total Completed Dictated Minutes
Minimum Required Minutes per Week
Jeana
40
450
600
0
Meagan
40
486
600
0
Sandra
40
550
600
0
Julia
40
611
600
$11.00
Tenille
40
665
600
$65.00
Total Amount of Incentive Pay
© 2014 Cengage Learning ®. All Rights Reserved.
Incentive-Based Compensation Program 4 The incentive pay per line above the required production is $0.15. You are given the daily production in Table 6-7. Calculate the weekly incentive pay for each transcriptionist using Table 68. Analyze the production of each transcriber and determine if minimum number of lines of transcription is met to receive incentive pay. Table 6-7 Program 4 Weekly Transcription Totals Weekly Transcription Line Totals: Incentive-Based Compensation Program 4
Transcriptionist
Monday
Tuesday
Wednesday
Thursday
Friday
Total
Jeana
1,070
1,250
1,135
1,030
1,290
5,775
Meagan
1,260
1,395
1,315
1,205
1,300
6,475
Sandra
1,325
1,415
1,300
1,205
1,395
6,640
Julia
1,140
1,255
1,230
1,335
1,230
6,190
Tenille
1,175
1,265
1,380
1,290
1,185
6,295
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Section 6 Management and Health Information Services 447
Table 6-8 Transcriptionist Incentive-Based Pay: Program 4 Transcriptionist Incentive-Based Pay: Program 4
Total Hours Worked
Total Complete Dictated Minutes
Minimum Required Lines per Week
Incentive Pay above Base
Weekly Incentive Production Met? Y/N
Jeana
40
5,775
6,000
0
N
Meagan
40
6,475
6,000
475 × 0.15
Y
Transcriptionist
$71.25 Sandra
40
6,640
6,000
640 × 0.15 $96.00
Y
Julia
40
6,190
6,000
190 × 0.15 $28.50
Y
Tenille
40
6,295
6,000
295 × 0.15
Y
$44.25 © 2014 Cengage Learning ®. All Rights Reserved.
Incentive-Based Compensation Program 5 The daily incentive pay per line is $0.13 from 800 to 1,099 lines, $0.15 for 1,100 to 1,399, and $0.16 for 1,400 and more. Use the information in Table 6-9 to calculate the daily incentive pay for each transcriptionist. Enter the daily incentive pay for each transcriptionist in Table 6-10. Table 6-9 Program 5 Daily Transcription Totals Daily Lines of Transcription: Incentive-Based Compensation Program 5 Transcriptionist
Monday
Tuesday
Wednesday
Thursday
Friday
Jeana
990
990
990
990
990
Meagan
990
990
989
995
1,122
Sandra
1,112
1,110
1,124
980
1,106
Julia
1,105
1,123
1,145
1,107
1,131
Tenille
1,157
1,132
1,137
1,123
1,116
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Section 6 Management and Health Information Services 448
Table 6-10 Program 5 Daily Incentive Pay Daily Incentive Pay Earned: Program 5 Transcriptionist Monday
Tuesday
Wednesday Thursday
Friday
Jeana
990 × 0.13 $128.70
990 × 0.13 $128.70
990 × 0.13 $128.70
990 × 0.13 $128.70
990 × 0.13 $128.70
Meagan
990 × 0.13 $128.70
990 × 0.13 $128.70
989 × 0.13
995 × 0.13
$128.57
$129.35
1,122 × 0.15 $168.30
Sandra
1,112 × 0.15 $166.80
1,110 × 0.15 $166.50
1,124 × 0.12 $168.60
980 × 0.13 $127.40
1,106 × 0.15 $165.90
Julia
1,105 × 0.15 $165.78
1,123× 0.15 $168.45
1,145 × 0.15 $171.75
1,107 × 0.15 $166.05
1,131 × 0.15 $169.65
Tenille
1,157 × 0.15 $173.55
1,132 × 0.15 $169.80
1,137 × 0.15
1,123 × 0.15 $168.45
1,116 × 0.15 $167.40
$170.55
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References Johns LaTour and Eichenwald-Maki Squazzo
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Section 6 Management and Health Information Services 449
CASE 6-18 Payroll Budget Decisions
Questions and Suggested Answers Budget Decision 1 The HIM director, Linda, has been given $15,000.00 for the overtime needed to catch up on the loose filing. If the average salary of the HIM clerical staff is $15.75 an hour, how many hours of overtime can be worked? Calculation: 15,000.00/15.75 = 952.38 hours Budget Decision 2 The HIM director, Carlotta, has been given $23,500.00 to hire temporary employees. If the temporary agency is charging $28.00 per hour, how many hours of temporary help will be available to Carlotta’s department? Calculation: 23,500.00 / 28.00 = 839.29 hours Budget Decision 3 The HIM director, Jose, has been given instructions that he cannot go over $8,100.00 in salary (including overtime) for the week of June 2–8. Based on the information provided in Table 6-11, how much is left in the salary budget for the week for loose filing? Table 6-11 Salary Expense Calculation Salary Expense for June 2–8 Employee
Number of Hours Worked
Salary
Total Earnings
Michaela
40
$15.35
$614.000
Glenn
40
$18.46
$738.40
Jerome
22
$17.78
$391.16
Natasha
32
$16.88
$540.16
Sarah
40
$19.66
$746.40
TOTAL
$3,070.12
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Calculation:
3,500 – 3,070.12 = $429.88 left in overtime budget allowance
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Section 6 Management and Health Information Services 450
Budget Decision 4 As the HIM imaging coordinator, you are in charge of reporting your staff payroll. Overtime is based on 80 hours per 2 weeks. The weekly hours for the past 2 weeks are shown in Tables 6-12 and 6-13. Your HIM director has asked you if you have had any overtime for this payroll. If so, who worked overtime and how many overtime hours did they work? The only employees having overtime were Glenn and Natasha, totaling 9.25 hours overtime for the work unit over the past payroll. Glenn had 6.75 hours and Natasha had 2.5 hours overtime. Table 6-12 Hours for Week 1 Hours Worked per Employee in Week 1 Employee Monday Tuesday Wednesday Thursday
Friday
Total
Michaela
8.0
7.5
8.5
6.25
8.0
38.25
Glenn
8.0
8.5
9.0
10.5
8.0
44
Jerome
8.0
7.5
3.0
10.0
8.0
36.5
Natasha
9.0
8.0
9.0
8.0
7.5
41.5
Sarah
8.0
9.0
8.0
8.0
7.5
40.5
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Table 6-13 Hours for Week 2 Hours Worked per Employee in Week 2, with Total Hours Week 1 and Weeks 1 & 2
Employee Monday Tuesday Wednesday Thursday Friday
Total Week 1
Total Weeks 1&2
Michaela
8.0
8.0
8.0
8.0
7.75
39.75
78
Glenn
10.5
8.0
8.0
8.0
8.25
42.75
86.75
Jerome
9.0
8.0
8.0
8.0
8.5
41.5
78
Natasha
8.0
8.0
8.0
8.0
9.0
41
85.5
Sarah
7.75
8.0
8.0
8.0
7.75
39.5
80
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Section 6 Management and Health Information Services 451
Reference LaTour and Eichenwald-Maki
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Section 6 Management and Health Information Services 452
CASE 6-19 Budgeting for Reducing Payroll
Questions and Suggested Answers Two of the facilities in the healthcare corporation you work for are going through a transitional period. As the divisional HIM director, you have been given the assignment to help with corporate finances by reducing payroll in the HIM Department in each of these facilities. Follow the instructions and complete the calculations, so that you can report the results for each of the HIM Departments undergoing reductions. Facility 1 You have been given the difficult assignment of reducing your payroll by 4% per week. 1. If the payroll is $15,348.45 for the week, how much amount should be reduced? Amount of reduction needed = 15,348.45 × 0.04 = $613.94 2. What will be the new weekly payroll? New weekly payroll after reduction = 15,348.45 − 613.94 = $14,734.51 Facility 2 All of the departments have been given instructions to reduce payroll costs. The HIM Department has been instructed to reduce payroll by 6% per week. 1. If your payroll is $20,149.99 for the week, how much amount should be reduced? Amount of reduction needed = 20,149.99 × 0.06 = $806.00 2. What will be the new weekly payroll? New weekly payroll after reduction = 20,149.99 − $806.00 = $19,343. 99
Reference LaTour and Eichenwald-Maki
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Section 6 Management and Health Information Services 453
CASE 6-20 Calculating Salary Increases The 5 HIM Departments that you manage have just completed the annual evaluations for your staff. Now you need to calculate the increase in payroll for each one.
Questions and Suggested Answers Facility 1 The hospital just announced a 3.5% raise across the board. What would be the new salaries after the 3.5% increase? Use the information in Table 6-14 to calculate the new salaries (round to the nearest cent). Table 6-14 Facility 1 Salary Increase Calculation Form Salary Increase Calculation Form: Facility 1 HIM Department Current Salary
Amount of Raise
New Salary
Michaela
$15.35
$15.35 × 0.035= 0.53725 = $0.54
15.35 + 0.54 = $15.89
Glenn
$23.46
$23.46 × 0.035= 0.8211 = $0.82
23.46 + 0.82 = $24.28
Jerome
$16.78
$16.78 × 0.035= 0.5873 = $0.59
16.78 + 0.59 = $17.37
Natasha
$18.88
$18.88 × 0.035= 0.6608 =$0.66
18.88 + 0.66 = $19.54
Sarah
$26.66
$26.66 × 0.035= 0.9331 = $0.93
26.66 + 0.93 = $27.59
Employee
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Section 6 Management and Health Information Services 454
Facility 2 The hospital just announced a 5% raise across the board. Use the information in Table 6-15 to calculate the new salaries (round to nearest cent). Table 6-15 Facility 2 Salary Increase Calculation Form Employee Nicole
Current Salary $38.54
Amount of Raise
New Salary
$38.54 × 0.05=
38.54 + 1.93 = $40.47
1.927 = $1.93 Brad
$25.53
$25.53 × 0.05= 1.2765 = $1.28
25.53 + 1.30 = $26.81
Jared
$15.22
$15.22 × 0.05= 0.761 =$0.76
15.22 + .71 = $15.98
Sophie
$21.22
$21.22 × 0.05= 1.061 = $1.06
21.22 + .1.06 = $22.28
Elizabeth
$21.66
$21.66 × 0.05 1.083 = $1.08
22.66 + 1.08 = $22.74
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Facility 3 The hospital has just announced raises. The amount of the raise is based on the employee’s performance evaluation. Based on the employee information in Table 6-16, calculate the new hourly salary for each employee (round to the nearest cent) and enter the information in Table 6-17.
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Section 6 Management and Health Information Services 455
Table 6-16 Facility 3 Evaluation Score and Amount of Raise Evaluation Score and Corresponding Amount of Raise Evaluation Score
Amount of Raise
5
5.0%
4
4.0%
3
2.5%
2
1.0%
1
0.0%
© 2014 Cengage Learning ®. All Rights Reserved.
Table 6-17 Facility 3 Calculation Form for Increase in Salary Calculation for Increase in Hourly Salary: Facility 3 Employee
Current Hourly Salary
Evaluation Score
Amount of Raise
Toni
$38.23
5 = 5%
1.9115 = 1.91
38.23 + 1.91 = $40.14
LaSha
$32.54
3 = 2.5%
0.8135= 0.81
32.54 + 0.81 = $33.35
Lori
$15.75
2 = 1%
01575=0.16
15.75 + 0.16 = $15.91
Gloria
$16.22
5 = 5%
0.811 = 0.81
16.22 + 0.81 = $17.03
Thaddeus
$25.85
3 = 2.5%
0.646 = 0.65
25.85 + 0.65 = $26.50
Gregg
$30.22
4 = 4%
1.2088 = 1.21
3022 + 1.21 = $31.43
Total Salaries
New Hourly Salary
$164.36 per hour
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Section 6 Management and Health Information Services 456
Facility 4 The hospital just announced raises. The amount of the raise is based on the employee’s performance evaluation. Based on the employee information in Table 6-18, calculate the new hourly salary for each employee and enter the information in Table 6-19. Table 6-18 Facility 4 Evaluation Score and Corresponding Amount of Raise Evaluation Score and Corresponding Amount of Raise Evaluation Score
Amount of Raise
5
6.0%
4
5.0%
3
3.0%
2
1.0%
1
0.0%
© 2014 Cengage Learning ®. All Rights Reserved.
Table 6-19 Facility 4 Calculation Form for Salary Increase Calculation Form for Salary Increase Employee
Current Hourly Salary
Evaluation Score
Amount of Raise
New Hourly Salary
Jennifer
$35.55
5 = 6%
2.133 = 2.13
$37.68
Grant
$29.65
2 = 1%
0.296 = 0.30
$29.95
Flora
$16.61
2 = 1%
0.166 = 0.17
$16.78
Louise
$18.55
5 = 6%
1.113 = 1.11
$19.66
Laura
$17.69
5 = 6%
1.059 = 1.06
$18.75
Mark
$21.93
4 = 5%
1.097 = 1.10
$23.03
Abigail
$24.22
3 = 3%
0.7266 = 0.73
$24.95
Total Salaries
$170.80
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© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 6 Management and Health Information Services 457
Facility 5 The hospital just announced raises. The amount of the raise is based on the employee’s performance evaluation as shown in Table 6-20. Table 6-20 Facility 5 Evaluation Score and Corresponding Amount of Raise Evaluation Score and Corresponding Amount of Raise Evaluation score
Amount of raise
5
5.0%
4
4.0%
3
2.5%
2
1.0%
1
0.0%
© 2014 Cengage Learning ®. All Rights Reserved.
Based on the employee information in Table 6-21, calculate the new annual salary for each employee and the total salary budget (round to the nearest cent). Table 6-21 Facility 5 Calculation Form for Salary Increase Calculation Form for Salary Increase: Facility 5 Employee
Current Annual Salary
Evaluation Score
Amount of Raise
New Annual Salary
Toni
$79,248.77
5 = 5%
3,962.44
$83,211.21
LaSha
$45,599.47
3 = 2.5%
1,139.99
$46,739.46
Lori
$31,657.44
2 = 1%
316.57
$31,974.01
Gloria
$31,555.95
5 = 5%
1,577.80
$33,133.75
Thaddeus
$45,578.33
4 = 4%
1,823.13
$47,401.46
Gregg
$44,558.04
3 = 2.5%
1,113.95
$45,671.99
Total Salary Budget
$278,198.00
.000
9,933.88
$288,131.88
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Section 6 Management and Health Information Services 458
The salary budget is based on the fiscal year (FY), which begins June 1. Salary increases will not take effect until October 1. Based on the employee information that you have calculated in Table 621, determine your payroll budget for the rest of the calendar year (beginning in June and ending in December). Then enter the information by month in Table 6-22. Table 6-22 Payroll Budget for Year Beginning June 1 Payroll Budget for Year Beginning June 1
Jun
Jul
Aug
Sep
Oct*
Nov
Dec
Totals
Toni
6604.06
6,604.06
6,604.06
6,604.06
6,934.27
6,934.27
6,934.27
47,219.05
LaSha
3,799.96
3,799.96
3,799.96
3,799.96
3,894.96
3,894.96
3,894.96
26,884.72
Lori
2,638.12
2,638.12
2,638.12
2,638.12
2,664.50
2,664.50
2,664.50
18,545.98
Gloria
2,629.66
2,629.66
2,629.66
2,629.66
2,761.15
2,761.15
2,761.15
18,802.09
Thaddeus
3,798.19
3,798.19
3,798.19
3,798.19
3,950.12
3,950.12
3,950.12
27,043.12
Gregg
3,713.17
3,713.17
3,713.17
3,713.17
3,806.00
3,806.00
3,806.00
26,270.68
Monthly Totals
23,183.16
23,183.16
23,183.16
23,183.16
24,011.00
24,011.00
24,011.00
Name
TOTAL
164,765.64
*
Denotes salary raises implemented.
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Reference LaTour and Eichenwald-Maki
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 6 Management and Health Information Services 459
CASE 6-21 Planning for Paper-Based Record Retention
You have been given the task of planning for paper-based record retention needs for each of the departments given below. Calculate the information needed to generate your report to administration. Questions and Suggested Answers Department 1 Use the information in Table 6-23 to calculate the average chart thickness (round to 1 decimal place). Table 6-23 Samples Taken to Determine Average Size of Chart Thickness Department 1
Sample Inch Measurements to Determine the Average Chart Thickness 0.2
4.0
0.5
3.5
0.5
0.25
0.5
0.4
0.25
2.75
0.5
0.75
0.75
0.75
0.75
4.0
0.5
0.75
1.25
1.25
1.25
1.5
1.75
1.0
3.25
1.5
1.75
3.75
0.25
0.75
© 2014 Cengage Learning ®. All Rights Reserved.
Add all the sample inch measurements = 40.85 inches Divide total inches (40.85) by number of charts (30) to get average inches per chart:
40.85 = 1.3616666 = 1.4 inches 30 Department 2 Calculate the linear filing inches required for 175,000 charts with an average size of 0.5 inch each. 175,000 × 0.5 = 87,500 inches
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Section 6 Management and Health Information Services 460
Department 3 Calculate the linear filing inches required for 576,000 charts with an average size of 0.75 inch each. 576, 000 × 0.75 = 432,000 linear filing inches Department 4 Calculate the linear filing inches required for 326,000 charts with an average size of 0.2 inch each. 326,000 × 0.2 = 65,200 linear filing inches Department 5 Calculate the linear filing inches required for 175,000 charts with an average size of 0.5 inch and a 25% allowance for future growth. 175,000 × 0.5 = 87,500 × 25% = 21,875 + 87,500 = 109,375 linear filing inches Department 6 Calculate the linear filing inches required for 576,000 charts with an average size of 0.75 inch and a 20% allowance for future growth. 576,000 × 0.75 = 432,000 × 20% = 86,400 + 432,000 = 518,400 linear filing inches Department 7 Calculate the linear filing inches required for 326,000 charts with an average size of 0.2 inch each and include a 35% allowance for future growth. 326,000 × 0.2 = 6,520 × 35% = 2,282 + 6,520 = 8,802 linear filing inches Department 8 Use the information in Table 6-24 to calculate the average chart thickness. Then calculate the linear filing inches required for 217,000 charts, including a 25% allowance for growth. Table 6-24 Samples Taken to Determine Average Size of Chart Thickness Department 8 Sample Measurements (in Inches) to Determine the Average Chart Thickness 0.75
3.0
0.75
2.25
4.0
1.5
0.25
0.5
0.25
2.50
4.0
1.75
0.10
1.75
0.75
3.0
4.0
0.75
© 2014 Cengage Learning ®. All Rights Reserved.
Total the sample chart measurements and divide by total number charts to find the average chart thickness. Then multiply the average chart thickness by the total number of charts to give the linear filing inches required for 217,000 charts. To plan for growth, multiply the total linear filing inches by the given 25% needed for growth expansion. 31.85 = total sample chart measurement
31.85 = 1.7694444 = 1.8 inches average chart thickness 18 © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 6 Management and Health Information Services 461
217,000 × 1.8 = 390,600 linear filing inches for 217,000 charts 390,600 × 25% = 97,650 additional linear inches needed for 25% growth 390,600 + 97,650 = 488,250 total linear filing inches needed with an allowance for 25% growth Department 9 Use the information in Table 6-25 to calculate the average chart thickness (round to 2 decimal places). Then calculate the linear filing inches required for 452,000 charts, including a 25% allowance for growth. Table 6-25 Samples Taken to Determine Average Size of Chart Thickness Department 9 Sample Measurements (in Inches) to Determine the Average Chart Thickness 1.0
2.2
0.2
1.75
3.7
2.50
3.0
5
5
2.75
5
0.50
2.5
0.7
2.2
5
5
© 2014 Cengage Learning ®. All Rights Reserved.
23.25 = total sample measurement charts 23.25 = 1.9375 = 1.94 inches average chart thickness 12
452,000 × 1.94 = 876,880 linear filing inches needed for 452,000 charts 876,880 × 25% = 219,220 linear inches needed for 25% growth 219,220 + 876,880 = 1,096,100 total linear filing inches needed, with an allowance for 25% growth Department 10 Macon General Hospital has 248,000 medical records with an average size of 0.75 inch per chart. How many shelving units are required if the shelves are 36 inches wide and there are 7 shelves in each unit? 248,000 × 0.75 = 186,000 filing inches needed for 248,000 medical records 36 × 7 = 252 linear filing inches per shelf 186,000 = 738.09523 = 738.1 shelving units 252
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Section 6 Management and Health Information Services 462
Department 11 Atlanta General Hospital has 758,200 medical records with an average size of 1.0 inch per chart. How many shelving units are required if the shelves are 36 inches wide and there are 6 shelves in each unit? 758,200 × 1 = 758,200 linear filing inches needed for 758,200 medical records 36 × 6 = 216 linear filing inches per shelf 758,200 = 3,510.1851 = 3,510.2 shelving units 216
Department 12 Perry Medical Center has 150,000 medical records with an average size of 0.5 inch. How many shelving units are required if the shelves are 33 inches wide and there are 8 shelves in each unit and a growth rate of 25% is desired? 150,000 × 0.5 = 75,000 linear filing inches needed for 150,000 medical records 33 × 8 = 264 linear filing inches per shelving unit 75,000 × 25% = 18,750 additional linear filing inches needed for 25% growth expansion 75,000 + 18,750 = 93,750 linear filing inches needed for current and predicted growth needs
93, 750 = 355.11363 shelves needed to store current and 25% growth needs 264 Department 13 Birmingham Pediatrics currently has 467,000 linear filing inches. The current shelves are nearing capacity. They want to increase filing capacity by 40%. They want to continue utilizing shelving units that are 33 inches wide and 7 shelves tall. How many new shelving units will be required? 467,000 × 40% = 186,800 additional linear filing inches needed for 40% growth 186,800 + 467,000 = 653,800 linear filing inches needed for current and predicted growth needs 33 × 7 = 231 linear filing inches per shelving unit
186,800 = 808.65 = 809 additional file units needed 231 Therefore, 809 more shelving units needed to accommodate additional 40% growth.
References Johns LaTour and Eichenwald-Maki
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Section 6 Management and Health Information Services 463
CASE 6-22 Planning for Electronic Record Retention
Questions and Suggested Answers You have been given the task of planning for electronic record retention needs for each of the departments given in the following sections. Perform the calculations necessary to report to administration. Department 1 You must decide how many CDs will be needed to store the scanned images of the existing medical records. Each CD stores 12,000 images. It is estimated that there are 750,852,214 images to store on the CDs. How many CDs would you need? 750, 852, 214
= 6, 257.1017 = 6, 258 CDs
12, 000
Department 2 You must decide how many CDs will be needed to store the scanned images of the existing medical records. Each CD stores 12,000 images. It is estimated that there are 1,538,535,515 images to store on the CDs. How many CDs would you need?
1,538,535,515 = 128, 211.292 = 128, 212 CDs 12, 000 Department 3 The 12-inch platters that have been selected for the new imaging system will each store 1,400,000 images via computer output laser disk (COLD). It was calculated that over the next 5 years there would be 129,956,493,345 images via COLD. How many of these platters should be purchased for the department? 129,956,493,345 = 92,827 platters 1,400,000
Department 4 The platters that have been selected for the new imaging system will store 14 gigabytes. There are 2,000,000 images and a scanned image averages 199 KB. How many platters will be needed? 199 KB × 2,000,000 images = 398,000,000 KB To go from KB to GB divide 10242 398, 000, 000 = 379.56238 GB 1048576
379.56238 = 28.111598 14 You would need 29 platters. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 6 Management and Health Information Services 464
Reference Bandwith Calculator (n.d.) What’s a Byte (N.D.)
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Section 6 Management and Health Information Services 465
CASE 6-23 Calculating Department Operations Budget
Questions and Suggested Answers Facility 1 Operations Budget You have been asked to calculate the operations budget for the HIM Department for the new FY. The hospital has announced that there will be a 2% increase in the operations budget across the board. Based on the current line items and FY budget shown in Table 6-26, calculate the new budget. Table 6-26 Line Items—Facility 1 Operations Budget Line Items for Operations Budget Line Item
Current Budget
New Budget
Supplies
$7,500.00
$7,500.00 + 2% = $7,650.00
Maintenance
$2,000.00
$2,000.00 + 2% = $2,040.00
Equipment
$12,000.00
$12,000.00 + 2% = $12,240.00
Software Licensing
$1,000.00
$1,000.00 + 2% = $1,020.00
Copy Machines
$5,000.00
$5,000.00 + 2% = $5,100.00
Folders
$15,000.00
$15,000.00 + 2% = $15,300.00
© 2014 Cengage Learning ®. All Rights Reserved.
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 6 Management and Health Information Services 466
Facility 2 Operations Budget You have been asked to calculate the operations budget for the HIM Department for the new FY. The hospital has announced that there will be a 2% increase in the operations budget across the board. In addition there will be a 5% increase in the maintenance costs and your software. Based on the current FY budget shown in Table 6-27, calculate the new budget. Table 6-27 Line Items— Facility 2 Operations Budget Line Items for Operations Budget Line Item
Current Budget
New Budget
Supplies
$5,500.00
$5,500.00 + 2% = $5,610.00
Maintenance
$2,000.00
$2,000.00 + 7% = $2,140.00
Equipment
$15,000.00
$15,000.00 + 2% = $15,300.00
Software Licensing
$1,500.00
$1,500.00 + 7% = $1,605.00
Copy Machines
$3,000.00
$3,000.00+ 2% = $3,060.00
Folders
$8,000.00
$8,000.00+ 2% = $8,160.00
© 2014 Cengage Learning ®. All Rights Reserved.
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 6 Management and Health Information Services 467
Facility 3 Operations Budget You have been asked to calculate the operations budget for the HIM Department for the new FY. The hospital has announced that there will be a 6% decrease in the operations budget across the board. Based on the current FY budget shown in Table 6-28, calculate the new budget. Table 6-28 Line Items—Facility 3 Operations Budget Line Items for Operations Budget Line Item
Current Budget
New Budget
Supplies
$6,000.00
$6,000.00 + 6% = $5,640.00
Maintenance
$3,000.00
$3,000.00 + 6% = $2,820.00
Equipment
$20,000.00
$20,000.00 + 6% = $18,800.00
Software Licensing
$1,500.00
$1,500.00 + 6% = $1,410.00
$2,500.00+ 6% =
$2,500.00 + 6% = $2,350.00
$5,500.00
$5,500.00 + 6% = $5,170.00
Copy Machine Folders
© 2014 Cengage Learning ®. All Rights Reserved. Facility 4 Operations Budget
You have been asked to calculate the operations budget for the HIM Department for the new FY. The hospital has announced that there will be a 5% decrease in the operation budget across the board. The budget must be cut even though maintenance and software licensing are being increased by 2%. Based on the current FY budget shown in Table 6-29, calculate the new budget.
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 6 Management and Health Information Services 468
Table 6-29 Line Items—Facility 4 Operations Budget Line Items for Operations Budget Line Item
Current Budget
New Budget
Supplies
$4,500.00
$4,500.00 − 5% = $4,275.00
Maintenance
$3,000.00
$3,000.00 − 5% = $2,850.00
Equipment
$4,500.00
$4,500.00 − 5% = $4,275.00
Software Licensing
$750.00
$750.00 − 5% = $712.50
Copy Machine
$800.00
$800.00 − 5% = $760.00
© 2014 Cengage Learning ®. All Rights Reserved.
References Cleverley and Cameron LaTour and Eichenwald-Maki
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 6 Management and Health Information Services 469
CASE 6-24 Net Present Value (NPV) Method of Evaluating a Capital Expense You are requesting approval of a capital expenditure for a new dictation system. The cost of the system is $65,000.00. You expect that the system will save the HIM Department $20,000.00 per year by eliminating the cost of outside contract transcription. You anticipate that the system life will be 5 years. Your facility uses straight line depreciation for the life of any capital expenditure. Assume that management requires the use of a net present value (NPV) of capital at 10%. Use the NPV shown in Table 6-30.Questions and Suggested Answers 1. Calculate the net cash flow. $75,815.72. 2. Would the dictation system meet the criteria to have a 10% return and exceed the initial capital outlay? Yes, the proposed system does have a 10% return that would exceed the initial capital investment of $65,000. The net present value (NPV) of the cash flow reflects $75,815.72, which is more than the capital expense ($65,000) to purchase the dictation system. The financial analysis presented in Table 6-30 reflects that the capital outlay would be recovered within 5 years. Table 6-30 Net Present Value at 10.0% Net Present Value at 10% Years
Net Cash Flow
Factor for NPV at 10.0%
Present Value of Cash Flow
1
20,000
$0.909091
18,181.82
2
20,000
$0.826446
16,528.92
3
20,000
$0.751315
15,026.30
4
20,000
$0.683013
13,660.26
5
20,000
$0.620921
12,418.42
Total
100,000
75,815.72
© 2014 Cengage Learning ®. All Rights Reserved.
References Abdelhak Cleverley and Cameron LaTour and Eichenwald-Maki © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 6 Management and Health Information Services 470
CASE 6-25 Accounting Rate of Return Method of Evaluating a Capital Expense
You want to get approval for a capital expense to bring the copy service back in-house. You estimate that it will bring in a net cash flow of $40,000.00 over the next 5 years. An initial outlay of $24,000.00 cash will be needed for 2 networked, dedicated computers and a new copy machine to support the ROI staff you already have.
Questions and Suggested Answers 1. Use straight-line deprecation in calculating the average net income and enter the information in Table 6-31. The accounting rate of return needs to be at least 10% for the project to be accepted. 2. Will the accounting rate of return be acceptable? Yes, because 13% exceeds the rate of return specified of at least 10%. Table 6-31 Accounting Rate of Return Accounting Rate of Return Net cash flow per year
Cash flow/number of years
40,000/5 = 8,000
Depreciation
Cost/number of years
24,000/5 = 4,800
Average net income
Net cash flow per year less depreciation
8,000 − 4,800 = 3,200
Investment
Cost of project
24,000
Accounting rate of return for project
Average net income/investment
3,200/24,000 = 0.13333 = 0.13
© 2014 Cengage Learning ®. All Rights Reserved.
References Abdelhak Cleverley and Cameron LaTour and Eichenwald-Maki
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 6 Management and Health Information Services 471
CASE 6-26 Payback Method of Evaluating a Capital Expense
You want to get approval for a capital expense to bring the copy service back in-house. An investment of $24,000.00 for a dedicated computer and a new copy machine will support the ROI staff you already have. You estimate that it will bring in a cash income of $40,000.00 over the next 5 years. Your facility uses straight-line depreciation to calculate the average net income.
Questions and Suggested Answers 1. Use Table 6-32 to figure the rate of return on the NPV and Table 6-33 to determine the number of years it will take for the payback. 2. Then, use the formula in Figure 6-2 to calculate the payback period. 3. How many years will it take to pay back the investment? The payback analysis reflects that the investment would be paid back in the 4th year. Table 6-32 Net Present Value at 10.0% Net Present Value at 10% Years
Net Cash Flow
Factor for NPV at 10.0%
Present Value of Cash Flow
1
$2,000
0.909091
$1,818.18
2
$5,000
0.826446
$4,132.23
3
$9,000
0.751315
$6,761.84
4
$11,000
0.683013
$7,513.14
5
$13,000
0.620921
$8,071.97
TOTAL
$40,000
$28,297.36
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© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 6 Management and Health Information Services 472
Table 6-33 Payback Method of Evaluating the Capital Expense for the In-house Copy Service Payback Method of Evaluating the Capital Expense for the In-house Copy Service Year
Average Net Income
0
Initial Investment
Remaining
$24,000
1
2,000
22,000
2
5,000
17,000
3
9,000
8,000
4
11,000
*(met)
5
13,000
TOTAL
40,000
*Payback of investment is met. © 2014 Cengage Learning ®. All Rights Reserved.
Initial Outlay (Investment)
= Payback Period
Average Net Income
Figure 6-2 Formula for the Payback Method © 2014 Cengage Learning ®. All Rights Reserved.
References Abdelhak Cleverley and Cameron LaTour and Eichenwald-Maki
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Section 6 Management and Health Information Services 473
CASE 6-27 Developing the HIM Operations Budget
Questions and Suggested Answers Develop the HIM Department operations budget on a spreadsheet for the next FY. Allocate the funding throughout the FY on a monthly basis. The FY at General Hospital begins July 1. First create a spreadsheet folder with the Salaries and Wages information, and then create a spreadsheet folder with the Operating Expenses.
Personnel Salaries and Wages Calculate amounts for 1. Salaries with fringe benefits 2. Allowed overtime Second, calculate total personnel budget. Use the information in Table 6-34 to calculate the payroll costs for the new FY. New salaries include: 1. A new approved Analyst/Coder/Abstractor position that will go into effect at the beginning of the new FY with a salary of $48,500.00. 2. Fringe benefits of 30% of monthly salaries. 3. A merit raise of 5% that will go into effect in December. 4. Overtime limits not to exceed $4,000.00 for the year.
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Section 6 Management and Health Information Services 474
Table 6-34 Personnel Salary Information Personnel Salary Information Number of Employees
Current Salaries
Salaries for New FY
Director
1
79,450 + 5% =
$86,422.50
Assistant Director
1
67,478 + 5% =
$70,851.90
Coding Supervisor
1
55,971 + 5% =
$58,769.55
Receptionist/Clerk
1
31,502 + 5% =
$33,077.10
Transcription Supervisor
1
56,800 + 5% =
$59,640.00
Transcriptionists
4
46,000 + 5% =
$48,300,00
Coders
3
47,500 + 5% =
$49,875.00
Chart Completion Supervisor
1
50,000 + 5% =
$52,500.00
HIM Technicians
2
44,052 + 5% =
$46,254.60
*
1
New position
$48,500.00
309,150 + 30% =
$151707.20
Classification
Analyst/Coder/Abstractor
SALARIES & FRINGE BENEFITS BUDGETED OVERTIME
$4,000
SUBTOTAL PERSONNEL
$155,707.20
*
Denotes new approved position
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Section 6 Management and Health Information Services 475
Operating Expenses: Operation expenses are shown in Table 6-35 and should be allocated throughout the FY. What would be the operations budget for the new FY, including line items given?
Table 6-35 Operations Expenses for New FY Operations Expenses for New FY Expense
Budget
Telephone
$1,000.00
Supplies
$10,500.00
Folders
$10,000.00
Equipment
$25,000.00
Copy Machine
$8,000.00
Education
$2,500.00
TOTAL
$57,000.00
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References Cleverley and Cameron LaTour and Eichenwald-Maki
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Section 6 Management and Health Information Services 476
CASE 6-28 Developing the HIM Department Budget
Questions and Suggested Answers Develop a budget for the HIM Department for the next FY at Sea Crest Healthcare Center. The FY begins July 1. Utilize spreadsheet software to develop the budget parts and then develop the department budget for the next FY. There are 3 parts to the budget: • Personnel (see Table 6-36) • Operational (see Table 6-37) • Capital equipment (see Table 6-38 and Figures 6-3 and 6-4) 1. Calculate the budget for each month and a total for the year. Line items to be included are identified in each of the 3 parts of the budget. Any limitations/instructions from administration are also provided. 2. Use the Capital Budget Expenditure Request Form (Figure 6-4) provided in completing and submitting a capital expenditure request for a new dictation system. Personnel Budget The FY personnel budget is indicated in Table.6-36. Remember that the salary raises will not go into effect until October of the FY. Instructions: Calculate fringe benefits as 25% of monthly salary. A 5% raise will go into effect in October. Limitations: Overtime cannot exceed $4,000.00 for the year. No new employees. Use a spreadsheet to calculate and reflect the monthly personnel budget.
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Section 6 Management and Health Information Services 477
Table 6-36 Information for Salary Budget Personnel Budget Position
Current Salary
Salary October 1
Director
$82,000.00
$86,100.00
Assistant Director
$74,000.00
$77,700.00
Receptionist/Clerk
$31,000.00
$32,550.00
Analysts/Coder/Abstra ctor
$46,000.00
$48,300.00
Analysts/Coder/Abstra ctor
$48,500.00
$50,925.00
Assembly Clerk
$30,000.00
$31,500.00
Transcriptionist
$45,000.00
$47,250.00
Transcriptionist
$47,000.00
$49,350.00
Part-time File Clerk
$16,500.00
$17,325.00
Salaries for New FY
$420,000.00 × $441,000.00 × 0.75 0.25 (1/4 of FY) (3/4 of FY) $106,250.00 $330,750.00
Line Items Total Salaries
437,270.00
Total Salaries and Fringe Benefits
437,270.00 × 1.25% (salaries plus 0.25% of salaries) $546,587.50
Overtime
$4,000.00
Total Salary Expenses for FY
$550,587.50
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Section 6 Management and Health Information Services 478
Use a spreadsheet to calculate and reflect the monthly operational budget. Operational Budget Table 6-37 Operational Budget Operational Budget Fiscal Year Operation
Budgeted
Telephone
$2,000.00
Supplies
$1,050.00
Folders
$10,000.00
Equipment
$22,000.00
Copy Machine
$5,000.00
Education
$5,000.00
TOTAL
$44,060.00
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Capital Equipment Budget Instructions: Complete the HIM Department’s Capital Equipment Budget for fiscal year. Note: The only major equipment request is to replace your current dictation system. Administration has distributed budget requests to each department at General Hospital with a memo indicating a due date of 1 month. Instructions state that the capital budget is “zero-based,” requiring justification of any proposed capital expenditures. You have listed some justifications for a new digital dictation system for the upcoming year in Figure 6-3. You need to complete the Capital Expenditure Approval Form shown in Figure 6-4 and return it to administration with your budget. As the HIM director, you know that after administration’s review of submitted department budgets, only those foreseen as most important will be approved and funded. For this exercise, include the dictation system in your capital budget as if it had been approved.
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Section 6 Management and Health Information Services 479
Table 6-38
Capital Equipment Infomation
Capital Equipment Item: New Dictation System Cost for System Annual Income Produced Depreciation over 5 Years
$65,000.00 $20,000.00 $13,000.00
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What would be included in the Capital Expenditure Request Form for the new dictation system? A sample capital expenditure request form could include the items shown in Figure 6-4.
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Section 6 Management and Health Information Services 480
Figure 6-4 Capital Expense Approval Form
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Section 6 Management and Health Information Services 481
Financial Analysis
Annual
Over 5 Years
A) Gross Revenue
$20.000_
$100,000.00
B) Less Depreciation
_($13,000.00)_________
($65000.00)
C) Gross Profit
$7,000.00_______
__$35000.00
D) Asset Cost
___$65,000.00
E) Return on Asset
10.8%
F) Payback—years
3.25
Requested by:________________________________(Department Manager)
Approved by: _______________________________ (Operations Manager) _______________________________ (Finance Manager) _______________________________ (Administrator)
Date Date Date
References Cleverley and Cameron LaTour and Eichenwald-Maki
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Figure 6-4 (Continued)
Section 6 Management and Health Information Services 482
CASE 6-29 Filing System Conversions
As an HIM assistant director, you have been asked by administration to help with the filing system conversions at 2 of the outpatient service facilities of your healthcare system. They have asked you to help them in calculating the number of employees needed to complete their projects.
Questions and Suggested Answers Project 1 Orthopedics of Central Omaha is converting the filing system from alphabetic to terminal digit. The front office staff consists of 8 FTEs. The practice manager has given instructions that the work can begin on Friday afternoon as soon as the last patient leaves, which is typically 5:00 p.m. The project must be completed by 8:00 a.m. Monday morning. The HIM coordinator has been collecting information for you to use in the planning process. There are 8,950 medical records. It takes 2 minutes per chart to convert from alphabetic to terminal digit.
1. Determine the number of hours that you expect it to take. 8,950 = 4, 475 minutes 2
4,475 = 74.583333 = 74.6 hours 60 2. Can everything be done by working the day shift, or will you need an evening and/or night shift to get the job completed on time? Since the time frame allowed for the project cannot begin until 5:00 p.m. on Friday and extends until 8:00 a.m. on Monday, this would allow a total of 63 hours around the clock to complete the project without breaks. The calculation on total number of hours to complete the conversion was approximately 75 hours without breaks. How many hours will be needed to complete the overall project will depend on the number FTEs that are assigned to the project. In addition, the HIM manager must consider rested employees will be needed Monday morning at 8:00 a.m. to begin the workweek. The HIM manager could ask 5 volunteers from the front office to complete the file conversion, or assign staff if not enough volunteers are received. If these are full-time employees, the project will pay overtime at time and one-half base pay. This could be an incentive for the staff to want to volunteer for the project. If the required 75-hour project is split among 5 employees, it could be completed with 15 hours devoted by each employee. This would eliminate the necessity of an evening or night shift on Saturday or Sunday to complete the conversion. The 5 volunteers could work an additional 3 hours on Friday evening to begin the file conversion. This would allow them to reduce the work hours to 6 hours on Saturday and 6 hours on Sunday to complete the project. Effective planning and training is necessary with projects to ensure that effective outcomes are achieved. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 6 Management and Health Information Services 483
3. How many people will be needed to complete the project in the time frame given? The number of staff will depend on managerial decisions to consider. Each decision will affect the other, such as the following: • How many shifts will be used to complete the file conversion? • What staff will be used to complete the project? • How many hours will be necessary to complete the conversion of charts from alphabetic to terminal digit files? Based upon the components of the project, the HIM manager must develop a plan on how the conversion will be handled and the number of staff members that will be used to complete the conversion. Project 2 Eastern Omaha Neurology Center is converting the filing system from alphabetic to terminal digit. There are 15 office staff members. The practice manager has given instructions that the work can begin on Friday afternoon as soon as the last patient leaves, which is typically 2:00 p.m. The project must be completed by 8:00 p.m. Sunday night. The HIM coordinator has been collecting information for you to use in the planning process. There are 54,760 medical records. It will take 3.5 minutes per chart to convert from alphabetic to terminal digit filing. 1. How many hours do you expect it to take?
54, 760 = 15, 645.71 = 15, 646 minutes 3.5 15, 646 = 260.7666 = 261 hours 60 2. How long will a shift be? This will depend upon the number of staff used to complete the project and the time constraints in which to complete the project. 3. How many people will be needed to complete the project in the time frame given? The number of staff will depend on managerial decisions. Each decision will affect the other, such as the following: • • •
How many shifts will be used to complete the file conversion? What staff will be used to complete the project? How many hours will be necessary to complete the conversion of charts from alphabetic to terminal digit files? Based upon the components of the project, the HIM manager must develop a plan on how the conversion will be handled and number of staff that will be used to complete the conversion. Considering the time requirement to complete this project, several staff members will be needed to complete this project within the allowed 54 hours. The manager knows that if you take the required hours to complete the project and divide it by the number of hours given to complete © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 6 Management and Health Information Services 484
project, you find that 4.83 staff members are needed to complete the project without breaks and around the clock. • The manager knows it is unrealistic to work only 5 staff members around the clock and have them rested to begin work Monday morning. It would be preferable to have 10 employees work the project on day-shift basis. If 10 staff members could work an extra 4 hours after 2 p.m. on Friday, it would give them a 12-hour shift that day. The 10 employees could return on Saturday and Sunday to work 11-hour shifts together and complete the project.
261 = 26.1 hours each employee 10 4. Can everything be done by working the day shift, or will you need an evening and/or night shift to get the job completed on time? The time frame allowed for the project is from 2 p.m. on Friday and extends until 8 p.m. on Sunday. This would allow 54 total hours around the clock to complete the project without breaks. The calculation on total number of hours to complete the conversion was approximately 261 hours without breaks. How many hours per day that will be needed to complete the overall project depends on the number of FTEs that are assigned to the project. Also, in deciding how many FTEs and how many hours they will need to work over the weekend, the HIM manager must consider that rested employees will be needed Monday to begin the work week. If the work is scheduled as above, only 1 shift a day for the employees will be needed.
References Abdelhak AHIMA Advantage 7:8 (December 2003) (n.d.)
LaTour and Eichenwald-Maki
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Section 6 Management and Health Information Services 485
References Abdelhak, M. (ed.). (2012). Health information: Management of a strategic resource. Philadelphia: W.B. Saunders. (Imprint of Elsevier, Inc.) AHIMA Advantage 7:7 (October 2003) (n.d.). Oops … I was wrong: When managers need to apologize. Accessed June 18, 2013 http://library.ahima.org/xpedio/groups/secure/documents/ahima/bok1_021553.hcsp?dDocName =bok1_021553 AHIMA Advantage 7:8 (December 2003) (n.d.). Where’s the payoff? Justifying training cost in tough economic times. Accessed June 18, 2013 from http://library.ahima.org/xpedio/groups/secure/documents/ahima/bok1_022487.hcsp?dDocName =bok1_022487 American Health Information Management Association (AHIMA) (2013). (n.d.) AHIMA 2010 salary study: Salary study delves deeper into factors driving pay. Accessed June 18, 2013, at http://hicareers.com/Toolbox/salarystudy.aspx American Health Information Management Association (AHIMA) (2012). (n.d.) Accessed June 18, 2013, from http://ahima.org Cleverley, W., & Cameron, A. (2011). Essentials of health care finance. Boston: Jones and Bartlett. Davis, N., & Marion, G. (20 Help wanted: Five steps to take before you hire. Journal of AHIMA, 73(3), 54–55(2002). Accessed June 18, 2013 from http://library.ahima.org/xpedio/groups/ secure/documents/ahima/bok1_010797.hcsp?dDocName=bok1_010797 Duggan, C. M. (2005). Designing effective training. Journal of AHIMA 76(6), 28–32. Bandwith Calculator. (n. d.) Accessed June 18, 2013, at http://easycalculation.com/bandwidthcalculator.php © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 6 Management and Health Information Services 486
Johns, M. (2011). Health information management technology: An applied approach (3rd ed.). Chicago: American Health Information Management Association. LaTour, K., & Eichenwald-Maki, S. (Eds.). (2010). Health information management concepts, principles, and practice (3rd ed.). Chicago: American Health Information Management Association. Liebler, J., & McConnell, C. (2012). Management principles for health professionals (6th ed.). Boston: Jones and Bartlett. McConnell, C. (2006). Umiker’s management skills for the new health care supervisor. Boston: Jones and Bartlett. McCuen, C., Sayles, N., & Schnering, P. (2007) Case studies in health information [DVD Series]. Clifton Park, NY: Thomson Delmar Learning. Squazzo, J. (2002). Tackling tough management issues: Advice from the top. Journal of AHIMA, 73(9), 72ff. What’s a Byte. Accessed June 18,2013 from http://www.whatsabyte.com; http://www.whatsabyte.com/P1/byteconverter.htm
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SECTION SEVEN Project and Operations Management
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Section 7 Project and Operations Management 488
CASE 7-1 Organizational Chart
Questions and Suggested Answers The hospital has just undergone a massive reconstructing in which the HIM Department has added 3 new functions: quality improvement, birth certificates, and research/institutional reporting. With these functions, the positions being moved to the HIM Department include Quality Improvement Coordinator, Physician Advisor, Quality Improvement Clerk, Research Coordinator, Report Writer, and Birth Certificate Coordinator. You have also received approval to hire 2 assistant directors. You plan to have 2 supervisors moving with the new staff to the HIM Department. Update the organizational chart to indicate the changes. While there is more than 1 correct way to organize the department, based on the information provided, Figure 7-1A shows an example of what the project may look like. Students should take into consideration similar tasks, knowledge, and skills when determining what functions should be grouped under 1 assistant director or 1 supervisor.
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Section 7 Project and Operations Management 489
Figure 7-1A Organizational Chart
References Abdelhak Davis and LaCour Johns LaTour and Eichenwald-Maki Liebler and McConnell
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Section 7 Project and Operations Management 490
CASE 7-2 Job Description Analysis
Questions and Suggested Answers 1. What would you recommend? The student should most likely recommend a coding career ladder. 2. If you recommend more than 1 job classification, what would they be? Students could recommend 2 or more levels of coding. They would most likely recommend 2 levels of coders—inpatient and outpatient. They could also recommend a third level if they assumed that the workload was adequate. In that case, it could be Outpatient Coder I, Outpatient Coder II, and Inpatient Coder. Alternatively, the student could choose to have 2 levels of inpatient coders and 1 level for outpatient coding, depending on the case mix index for the facility. The 2 levels of inpatient coders are the most common and therefore the most logical response. 3. How would you divide the workload? If there are 2 levels, inpatient and outpatient divisions, the inpatient coder would do all inpatient charts and the outpatient coder would do all the outpatient visits. If you had 2 levels of outpatient coders, you could have the lower level outpatient coder do ancillary charts, since this type of coding can be performed by less skilled coders. The higher level outpatient coder would do the ER and outpatient surgery charts, since this takes higher skills. If you have 2 or more coders in the same level, you would need to have some mechanism to divide the work between the employees in that level. This could be done by dividing primary digits of the medical record number (like the terminal digit) or dividing the alphabet (like the first letter of last name) between the coders. Dividing the charts based on service is not recommended, since it makes it difficult to cross-train employees to cover for each other.
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Section 7 Project and Operations Management 491
References Abdelhak Davis and LaCour Johns LaTour and Eichenwald-Maki
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Section 7 Project and Operations Management 492
CASE 7-3 Productivity Study
Questions and Suggested Answers 1. Do you need any additional information? You should know the productivity requirements for the staff members at the other hospitals who abstract the quality indicators. 2. If so, where would you go to get the information? You could contact the same hospitals, talk to the quality management departments, and ask for the productivity standards for the quality improvement abstractors. 3. What arguments can you use to support your need for the additional staff? You should combine the productivity data from the quality indicators together with the coding to paint a complete picture of the staffing needs for the functions. If you wanted to omit the responsibility of entering the quality indicators, you could use the other facilities’ examples and send them to quality management. If you want to keep the functionality, then you could use the information in your request to add additional coders or to separate the functions between 2 groups of employees.
References Abdelhak Davis and LaCour Johns LaTour and Eichenwald-Maki
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Section 7 Project and Operations Management 493
CASE 7-4 Performance and Quality Improvement in a Coding Department
Questions and Suggested Answers 1. What additional information should Molly gather? She will need to calculate the productivity to determine if she has an adequate number of staff. She may also want to do some time studies or contact other facilities to determine if the productivity levels are appropriate. She may also want to investigate the vacant position. She would need to know if it has been open for a long time, if they are having trouble getting qualified candidates, and if their salary and other benefits are competitive. She will need to know why the Discharge Not Final Billed (DNFB) is so high. There could be other factors involved other than coding. She will also need to develop a list of options that need to be considered in reducing the DNFB. She will need to identify options regarding improving compliance monitoring. 2. What are Molly’s options? Her options for reducing DNFB are as follows: •
She can bring in consultants to get the report done quickly.
•
She could hire temporary coders to get the DNFB down.
•
She may want to hire some local coders to work on a PRN (prn is Latin for “Pro Rae Nada,” which means as needed) basis to help with backlogs once the problem is resolved.
•
She could also require the staff to work overtime.
•
In the long term, Molly will need to address documentation issues if poor documentation or missing discharge summaries are part of the problem of the DNFB increase (e.g., motivating physicians to complete discharge summaries timely, or filling vacant positions to reduce backlog of work).
Molly has 2 options for the lack of time spent on compliance issues: © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 7 Project and Operations Management 494
•
She can delegate some of her other responsibilities to make time for the compliance activities.
•
She can bring in someone else to help her with the compliance monitoring. This person could be from another department, a consultant, or a new position.
3. How can you ensure quality of coding while at the same time emphasizing volume? •
You can make quality as important as productivity in the employee’s evaluation.
•
There should be high quality standards that are enforced with routine monitoring. (The standards typically range from 95% to 98%.)
•
You could monitor the case mix index.
•
You can reinforce both quality and productivity at training and coding meetings, and in informal conversations.
•
Incentive programs for the coders could be an option; however, there are risks involved.
4. What solution would you recommend to Molly’s problems? Students have a lot of flexibility in what they could propose. They should select their recommendation from the above-listed options. It would have to address a quick resolution to the DNFB problem and a way to keep the DNFB down after the initial clean-up. This should include filling the vacant position and keeping the positions filled. The plan would also have to address how to improve compliance monitoring, such as a full-time or even part-time person to help the supervisor.
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Section 7 Project and Operations Management 495
References Abdelhak Davis and LaCour Johns LaTour and Eichenwald-Maki
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Section 7 Project and Operations Management 496
CASE 7-5 Performance Improvement for a File Area
Questions and Suggested Answers 1. What changes would you recommend? Students should recommend adding accountability into the process. This can be done by the following: •
Designating specific staff members to pull and file charts and to file loose material.
•
Assigning specific staff members the responsibility of specific terminal digit sections whenever feasible. This includes staff members who file loose material and medical records.
•
Assigning specific requestors or requestor types rather than terminal digits to staff members who pull charts.
•
Monitoring quality and reporting productivity, so that the employees know that they are expected to meet certain requirements in quality of work and volume of work.
2. How would you implement your plan, if it is approved by the director? The first thing for the students to do would be to come up with a formal plan that outlines who would do what regarding pulling, filing, and loose material. Then the decision should be made on how to divide the work, such as by terminal digit for filing or type of requestor for pulling charts. After all of the details have been worked out, the supervisor should meet with the staff and explain what is going to happen and why it is necessary. The new process should begin the next day. The supervisor should make sure that he or she was available for at least several days to ensure that the new process goes smoothly. The supervisor should then check back with the staff frequently in the days and weeks following to see how things are going and to provide feedback to the employees. After the kinks, if any, in the system have been worked out, the supervisor would need to begin the quality audits to ensure that the quality of the work is acceptable. After the new system is working smoothly, the supervisor should check with the © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 7 Project and Operations Management 497
requestors to see if there has been an improvement. A student may prefer a more participatory management style and get the staff involved in the planning process and even get their preferences as to the type of work they want to do.
References Abdelhak Davis and LaCour Johns LaTour and Eichenwald-Maki
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Section 7 Project and Operations Management 498
CASE 7-6 Instituting Productivity and Quality Standards for Imaging or Scanning Records
Questions and Suggested Answers 1. Use form design principles to develop the productivity report required. A sample form for the productivity reporting is shown in Figure 7-6A. Figure 7-6A Weekly Productivity Report Weekly Productivity Report Employee name: Week of : Task
Monday Tuesday Wednesday Thursday Friday
Number of inpatient charts prepped Number of outpatient charts prepped
Number of outpatient charts scanned Number of documents rescanned Date currently scanning Number of hours worked Amount of time scanner is down Other: Please specify Comments
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Number of inpatient charts scanned
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Section 7 Project and Operations Management 499
2. What would you recommend to get the scanners caught up in their work? Productivity reports are necessary. In addition, you would need to educate the staff on the importance of getting the documents scanned into the system accurately as well as quickly. You could explain that problems arise with patient care and healthcare operations when the information is not available. While this is important, it may not be enough to motivate the staff to get the backlog down. To get the backlog down, you would need to hire temporary employees or do overtime with your current staff. Because you only have so many scanners, you may have to work 2 or more shifts and even weekends. 3. How will you establish productivity standards? You would need to do a time study. You would need to include any preparation for scanning when setting the standards. The 2 figures could be combined or reported separately. You would most likely contact other facilities who also scan documents for information on their productivity standards and how they developed them.
References Abdelhak Davis and LaCour Johns LaTour and Eichenwald-Maki
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Section 7 Project and Operations Management 500
CASE 7-7 Evaluation of Transcription Department Because you have been having difficulty recruiting transcriptionists, you are considering outsourcing the transcription services. You have the responsibility of making the decision. Based on the information that has been collected, you have to decide which is more cost-effective. The following list includes additional information regarding in-house transcription: • • • • •
Expenses caused by overhead are $4,500.00 per year 500 square feet of space have been allocated Number of lines transcribed a month: 225,000 Benefits are 24% of salaries If you retain transcription in-house • You will have to increase salaries by 20% to be competitive. (This figure is based on salary surveys of local hospitals and major transcription services.) • You will need an additional 50 square feet to accommodate 2 more transcriptionists
Table 7-7A shows the current in-house transcription services with the transcriptionist positions, hourly rates, and annual salaries. The average of positions 1 through 10 were used to calculate an average which was used for hourly rates for transcriptionists 11 and 12. The hourly rates were multiplied by 2,080 to obtain an annual salary (40 hours per week times 52 weeks a year). Table 7-7A In-House Transcriptionist Positions and Annual Salaries In-House Transcriptionist Positions and Annual Salaries Position
Hourly Rate
Annual Wages
Transcriptionist 1
$21.76
$45,260.80
Transcriptionist 2
$18.23
$37,918.40
Transcriptionist 3
$19.47
$40,497.60
Transcriptionist 4
$18.72
$38,937.60
Transcriptionist 5
$19.06
$39,644.80
Transcriptionist 6
$17.76
$36,940.80
Transcriptionist 7
$18.84
$39,187.20
Transcriptionist 8
$17.37
$36,129.60
Transcriptionist 9
$19.27
$40,081.60
Transcriptionist 10
$19.84
$41,267.20
Transcriptionist 11 (vacant
$18.99
$39,499.20
position) © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 7 Project and Operations Management 501
Transcriptionist 12 (vacant
$18.99
$39,499.20
Supervisor
$29.02
$60,361.60
Transcription Clerk
$15.75
$32,760.00
position)
Total Annual Wages
$567,985.600
© 2014 Cengage Learning ®. All Rights Reserved.
An RFP was utilized to gather information on several transcription companies. You have decided which company you will go with if the decision is made to outsource. Key information regarding
© 2014 Cengage Learning ®. All Rights Reserved.
outsourcing transcription and your projected volume is shown in Figure 7-2.
Figure 7-2
Outsourcing Transcription
To obtain the annual cost of outsourcing transcription follow the steps below: 1. Multiply the number of lines transcribed a month (225,000) by the expected increase in transcription per month (1.12%) and then multiply that value by the cost per line (17 cents) and then multiply by 12 months: 225,000 × 1.12 = 252,000 lines 252,000 × 0.17 = $42,840 $42,840 × 12 = $514,080
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Section 7 Project and Operations Management 502
2. Salary cost would be the wages for the current transcription supervisor $60,361.60. 3. Benefits would be 24% of $60,361.60 ($60,361.60 × 0.24 = $14,486.78). 4. The overhead is calculated by the amount of space used. Using outsourcing decreased the overhead since they will only need 50 square feet of space. Divide the current overhead expenses by space used ($4,500 divided by 500 square feet of space). The cost per square foot in overhead is $9.00. Outsourcing requires 50 square feet with an overhead cost of $450.00.
Questions and Suggested Answers 1. Which method would you recommend from a strictly financial aspect? Table 7-7B presents the annual transcription costs for in-house and outsourced transcription services. Table 7-7B Annual Transcription Costs for In-House and Outsourced Transcription Services Transcription Cost for In-House and Outsourcing Transcription Services Transcription Cost
In-House
Outsourcing
Salaries
$567,985.00
$60,361.60
Benefits for transcriptionists
$136,316.40
$14,486.78
Overhead
*
$4,9500.00
Transcription services Total Cost
$450.00 $514,080.00
$704,301.40
$$589,378.38
© 2014 Cengage Learning ®. All Rights Reserved. *
Includes an additional 50 square feet of space that will be needed to keep transcription in-house. From a purely financial standpoint, outsourcing is the more efficient strategy.
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Section 7 Project and Operations Management 503
2. What other issues should be reviewed before making this decision? You will need to review turnaround time for the reports, quality of the outsourced transcription, privacy and security issues, and the possibility that your dictation may be subcontracted (some of which may be overseas). The contract terms would have to be reviewed to ensure that they are acceptable. 3. What additional information do you need to make a decision? You would want to check with other facilities that have outsourced their transcription to see if they are satisfied with their decision. You would need additional information including turnaround times, quality guarantees, and weekend, night, and holiday coverage, as well as other contract terms.
References Davis and LaCour Johns LaTour and Eichenwald-Maki
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Section 7 Project and Operations Management 504
CASE 7-8 Performance and Quality Evaluation and Improvement of Health Information Management (HIM) 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 remaining 25% of the record is paper and is scanned into the system by the HIM Department. These documents are scheduled for destruction in 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, she 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 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.
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Section 7 Project and Operations Management 505
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 2 words—FIX IT. While the director will be actively involved in this 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: •
There is a 2-month backlog in scanning the paper records.
•
The quality of the scanning has problems. 1. Sometimes pages are fed 2 at a time, and the backs of pages are not always scanned. 2. This requires 100% audit, which is 3 months behind. 3. The staff members conducting the quality audits do not catch all of the errors.
•
•
Billing: •
The billing hold report is over $2,000,000.00.
•
Administration wants the billing hold report held at $500,000.00.
Coding: •
Coding is 2 weeks behind.
•
There are 3 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.
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Section 7 Project and Operations Management 506
•
Release of Information: •
The release of information area is 2 days behind.
•
The release of information area has received repeated complaints that the wrong information is being sent. The errors include: 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.
•
Although the transcription is current, the quality of the work is inconsistent. Most of the reports are perfect, but a significant number of reports are totally inaccurate due to: 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 you should have
•
Who you should report to
•
What accuracy rates you expect © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 7 Project and Operations Management 507
•
What you will do to solve problems (training, outsourcing, new policies, etc.)
•
What will be monitored
•
Frequency of monitoring
•
Frequency of reporting
•
What investigations you will do
•
How you will build quality into your process
•
How you will prioritize problems to be addressed
•
Forms
•
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 all aspects of the issues, including but not limited to legal, data quality, compliance, and quality improvement.
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Section 7 Project and Operations Management 508
Questions and Suggested Answers •
Who should be involved? The supervisor for each area should be involved, as should the staff for each area. You may need to get the billing department involved, depending on the reasons why the billing hold report is elevated. Staff members from each area should also be involved, since they know the work well. They can provide insight into the problems that the supervisors may not be able to.
•
What reporting mechanism you should have? There should be weekly productivity reports generated by the staff. The supervisors should combine the weekly reports into monthly reports. There should be a daily report providing the size of the backlog. There should be at least monthly quality improvement audits. The supervisors should report their findings to the assistant director or director who should trend the reports.
•
Who you should report to? The supervisors should report to the assistant director or director. The assistant director should report the consolidated reports to the director.
•
What accuracy rates you expect? The students have a lot of flexibility here. The standards should be high but obtainable. Coding accuracy rates usually fall between 95% and 98%. The other standards should be around this level as well.
•
What you will do to solve problems (training, outsourcing, new policies, etc.)? •
Scanning: Both the quality issues and the backlog need to be addressed by the student. Options for the backlog include temporary employees, overtime, and adding additional staff members. The additions to the staff would only be appropriate if the research shows that there is too much work for the current staff to handle. The quality issues may be caused by the scanner, the staff, or both. Research should be able to determine the cause. If the issue is staff related, there should be training and counseling. If improvement does not occur after the training and counseling, then progressive disciplinary steps should be taken. If the cause
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Section 7 Project and Operations Management 509
is technological, then maintenance should be performed on the scanners. If that does not solve the problem, then the scanner(s) should be replaced. The 100% audit should be continued until the problem(s) is resolved. •
Billing: Research needs to be conducted to determine why the billing hold report is so high. The assumption would be that coding is behind, but there may be other contributing reasons such as missing discharge disposition or billing problems. The plan would be developed based on the findings of the research.
•
Coding: Options include hiring coding consultants, PRN coders, overtime, and filling the vacant positions. Since there are 3 positions vacant, it is easy to assume that they have been vacant for an extended period of time. It is unlikely that you would be able to fill the positions and get the new employees through orientation and training in time to be of any immediate use in clearing the backlog. Filling the positions is important in keeping the coding caught up once the overtime and/or additional staff is eliminated. You may need to try different strategies to find the employees (i.e., you may need to advertise nationally in order to find candidates for the coding positions). As far as the new graduate is concerned, it will simply take time to get her up to speed. There is not much that can be done to speed up the process. The advantage with working staff overtime is that the overtime could start immediately and your staff is already trained in your procedures and information systems. Overtime would help, but the disadvantage is that your staff are not as efficient when they are tired. The most logical strategy would be to bring in consultants. This can be done relatively quickly and you can bring in enough coders to eliminate the backlog quickly.
•
Release of Information: The backlog in this area is relatively minor since it is only 2 days. This backlog could be eliminated by just working 1 weekend if the problem is just preparing records for release (e.g., logging and copying records to send). If the backlog of release of information is due to reports that are unavailable (e.g., discharge summaries or other reports that have not been dictated), then those problems will need to be resolved before the backlog can be completely cleaned up. Regarding the quality of the work performed, the staff need to be retrained and/or counseled. If quality problems continue, then progressive
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Section 7 Project and Operations Management 510
disciplinary actions should be taken. The errors should be reported to the chief privacy officer as they occur so that proper investigation and mitigation can occur. •
Transcription: The contract with the transcription company should be reviewed to verify that if quality problems are not resolved, the contract can be canceled. The director then should meet with the transcription company and notify them that if the quality problems are not resolved by a certain date, the contract will be canceled. In addition, the contact should tell you if you can deduct the cost of the report with quality problems from the amount that you owe.
•
What will be monitored? •
Scanning: Number of charts scanned by patient type, backlog, date of charts being scanned.
•
Billing: Billing hold report amount.
•
Coding: Number of charts coded by patient type, backlog, date of charts being coded.
•
Release of information: Number of requests processed, amount of backlog, number of new requests received, amount of money received, amount of accounts receivable, and number of copies made.
•
Transcription: Number of lines (or minutes) transcribed, date of transcription, and amount of backlog.
•
Frequency of monitoring The employees need to track their performance on a daily basis.
•
Frequency of reporting The employees should report their daily activities to their respective supervisor on a weekly basis. The supervisor would report it to the director or assistant director on a monthly basis.
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Section 7 Project and Operations Management 511
•
What investigations will you perform? •
The supervisor would need to determine why the errors are being made so that the appropriate corrective actions could be taken.
•
Scanning: The investigations could be to identify the scanner used or the employee involved.
•
Coding: The investigations would include recruitment methods used to fill the coding positions and coding companies that could be hired to eliminate the backlog.
•
Transcription: You would investigate to see if there is a pattern in the quality errors, review the contractual agreement between your facility and the transcription company, and look for another transcription company that could replace your existing company if necessary.
•
How will you build quality into your process? •
Scanning: This process already has quality built into it.
•
Billing: This is not applicable.
•
Coding: There need to be strict coding procedures, ongoing reviews, outside audits, stability in employees, and emphasis on the quality of coding as well as quantity.
•
Transcription: There is already a quality process in place, since you know the issues involved. The problem should be turned over to the transcription company for them to resolve.
•
How will you prioritize the problems to be addressed? All of these problems are serious and need to be addressed quickly. The most serious legal issues are the release of information quality and the poor coding quality. Because of the legal ramifications, these should be the first priorities. Next would be the backlog in coding, since this impacts the facility financially. The transcription quality problems should be next. The billing problem would be solved with the elimination of the coding backlog. The lowest issue © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 7 Project and Operations Management 512
on the list is the scanning problems. This is not to say that this is an insignificant problem, but it probably has the least impact on the organization. Many of these could be addressed at the same time. For example, you could call the transcription company about the problems and threaten them with canceling the contract while you are working on release of information and coding quality issues. You may be able to divide the problems between assistant directors or supervisors to get the problems resolved quickly. •
Forms There should be productivity forms, quality audit forms, and monthly reports.
•
Graphs Graphs could be used as tools to quickly monitor trends for each area. Examples of what could be graphed are backlogs, charts coded, number of lines transcribed, number of coding errors, and number of scanning errors.
References Abdelhak Davis and LaCour LaTour and Eichenwald-Maki
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Section 7 Project and Operations Management 513
CASE 7-9 Creating a Workflow Diagram for Discharge Processing
Questions and Suggested Answers You have been asked to draw a workflow diagram to illustrate the discharge process in our HIM Department. Show key steps in process, not every step. Students should identify the key functions from the list provided in the case study and use the appropriate symbol for process, manual input, decisions, or other appropriate shapes. The workflow diagram will vary in appearance. An example of what the student could do is shown in Figure 7-9A.
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© 2014 Cengage Learning ®. All Rights Reserved.
Section 7 Project and Operations Management 514
Figure 7-9A Workflow Diagram
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Section 7 Project and Operations Management 515
References Abdelhak Davis and LaCour LaTour and Eichenwald-Maki
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Section 7 Project and Operations Management 516
CASE 7-10 Improving Workflow Process for Performance Improvement for Discharge Processing
Questions and Suggested Answers 1. What changes can you recommend to accomplish your goals? There are many different models that could be used by the student. One possibility is as follows: •
The charts are to be picked up from the unit at midnight of the day of discharge.
•
The charts are to be checked off the discharge list.
•
The charts are then assembled and analyzed on the midnight shift.
•
The next day, the charts are coded and abstracted.
•
On the second day post discharge, the quality indicators are abstracted.
•
On the evening shift of the second day, the incomplete charts are filed in the physician’s incomplete chart area and the completed charts are filed in the permanent file area.
•
Loose material is to be filed throughout the process.
2. What impacts (positive and negative) do you expect? Positive impacts expected include the following: •
There would be faster accessibility of the chart for completion.
•
Charts would be better prepared to go to ER or the floor if the patient is readmitted.
•
Charts are coded more quickly, therefore lowering the DNFB.
Negative impacts could include the following: •
Coding without the loose material could cause compliance and/or quality problems.
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Section 7 Project and Operations Management 517
•
The process could be derailed, with backlogs affecting the next step in the process if you are short-staffed in an area.
3. What could you do to diminish the impact of the negative outcomes? Some possibilities include the following: •
Coders could review a random sample of the charts a second time.
•
Coders could use the computer information systems to access some information that may not be filed on the chart.
•
Develop rules about when the coders need to wait to code the charts.
•
Have a floater to cover whenever someone is off or the work is behind.
•
Have PRN staff to cover whenever someone is off or the work is behind.
References Abdelhak Davis and LaCour Johns LaTour and Eichenwald-Maki
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Section 7 Project and Operations Management 518
CASE 7-11 Physical Layout Design for Health Information Management (HIM) Department
Questions and Suggested Answers Design the physical layout for the HIM Department for a 250-bed acute care hospital. The students have a lot of flexibility in this assignment. They should take into account good design principles including but not limited to the following: •
Supervisors are located near staff who report to them.
•
Workflow should be considered.
•
There has to be workspace for all staff, even if employees on different shifts have to share.
•
The employees need computers, phones, and other resources.
•
There should be a legend to explain the symbols used.
•
The layout should be designed according to the requirements of the assignment.
•
Aisle size should be appropriate for the traffic level.
•
Privacy and security should also be considered.
Reference LaTour and Eichenwald-Maki
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Section 7 Project and Operations Management 519
CASE 7-12 Revision of Information Management Plan
Questions and Suggested Answers 1. Develop a project plan for the revision of the information management plan. •
What steps need to be done? See Table 7-12A.
•
Who is responsible for each? See Table 7-12A.
•
How long will you allocate to each step? See Table 7-12A.
The student has a lot of flexibility here. Table 7-12A shows an example of what the student could do. 2. Develop a Program Evaluation Review Technique (PERT) chart of the project. A sample PERT chart of the project is shown in Figure 7-12A. Table 7-12A Revision of Management Plan by Task, Responsible Party, and Time Allocated
Revision of Management Plan by Task, Responsible Party, and Time Allocated Task
Responsible Party
Time Allocated
Train department heads
HIM director
1 day
Write sections of information
Department directors
1 month
Review sections
HIM director
2 weeks
Revise sections of the plan
Department directors
2 weeks
management plan
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Section 7 Project and Operations Management 520
Compile document
HIM director
1 week
Obtain approval
Administration and other designees
2 weeks
Upload plan onto intranet
Webmaster
1 day
Notify appropriate staff that the
HIM director
1 day
plan is now available © 2014 Cengage Learning ®. All Rights Reserved.
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© 2014 Cengage Learning ®. All Rights Reserved.
Section 7 Project and Operations Management 521
Figure 7-12A PERT Chart for the Revision of IM Plan
References Abdelhak LaTour and Eichenwald-Maki
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Section 7 Project and Operations Management 522
CASE 7-13 Defining a Project
Questions and Suggested Answers Review the situation in Table 7-4. Indicate whether each situation meets the definition of a project or not. Explain why it is or is not a project. Table 7-4 Which Scenarios Are Projects
Scenario and Rationale
Project Yes No
1. Scenario: The assistant director is ordering the annual supply of medical record
X
folders. He or she is taking bids from vendors to get the best price. Rationale: This is a routine process that happens every year. There would not be a separate budget or specific start/stop dates. 2. Scenario: You are developing a new PI program. Data will be abstracted into an
X
information system with reports being generated monthly. Rationale: This is an ongoing process, so there is not a specific start/stop date. 3. Scenario: You are converting your filing system from alphabetic to terminal
X
digit. Rationale: This is a finite process and has all of the characteristics of a project. 4. Scenario: You are installing new cubicles in the HIM Department.
X
Rationale: This is a finite process and has all of the characteristics of a project. 5. Scenario: The state is updating its electronic birth certification software, which
X
will be rolling out to all of the hospitals over the next 6 months. Rationale: This is an ongoing process. The update is not a full implementation but © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 7 Project and Operations Management 523
a routine upgrade. It does not have set start/stop dates, specific objectives, or other elements of a project. 6. Scenario: The Information Management plan is being revised. The HIM special
X
projects coordinator has been given sole responsibility of the revision. Rationale: This may or may not be a project. It would have specific objectives, a final product, and resources allocated. We do not know if there is a separate budget or defined start/stop dates. 7. Scenario: You are developing new productivity standards for your HIM
X
functions. Rationale: This is routine management responsibility. There would not be a specific cost allocated and this may not have specific start/stop dates. 8. Scenario: Your Joint Commission survey is scheduled sometime around the end
X
of the year. You have a lot of work to ensure that everything is in place. Rationale: This is an ongoing process, since the Joint Commission has unannounced surveys. Also, it is unlikely to have the expenses allocated to a separate budget. 9. Scenario: The annual coding update has been sent to you for installation.
X
Rationale: This is a routine process. It has no separate budget, no specific objectives, or deliverables. 10. Scenario: The monthly employee newsletter is being written for release next
X
week. Rationale: This is a routine task. There would not be a separate budget, specific start/stop dates, or objectives. © 2014 Cengage Learning ®. All Rights Reserved.
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Section 7 Project and Operations Management 524
Reference LaTour and Eichenwald-Maki
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Section 7 Project and Operations Management 525
CASE 7-14 Job Description for Project Manager
Questions and Suggested Answers What problems do you see with the Project Manager Job Description in Figure 7-4? •
Skills: There are skills missing on the job description (i.e., strong communication skills, facilitation skills, and analytical skills). Knowledge of Microsoft Project should be added, since it is an important tool for a project manager to use.
•
Job responsibilities: All job descriptions should have the “other duties as assigned” statement. Since leadership is such a key responsibility of the project manager, it should be part of the job responsibilities. Another responsibility is the ability to juggle multiple projects simultaneously.
•
Experience: Job description should require or at least prefer project management experience.
References Abdelhak Davis and LaCour LaTour and Eichenwald-Maki Liebler and McConnell
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Section 7 Project and Operations Management 526
CASE 7-15 Forming Committees
Questions and Suggested Answers 1. Who would you place on each subcommittee? The students have a lot of flexibility but should consider the responsibility of each subcommittee when assigning representatives. Subcommittees should have clinical, administrative, information systems, and other representatives as appropriate. Suggested subcommittees and members are shown in Table 7-15A. Table 7-15A Suggested Subcommittees and Members
Suggested Subcommittees and Members •
HIM Director
•
Project leader
•
Vendor
•
System Analyst
•
Director, Training
•
Director, Cardiovascular services
Data Management Committee
•
Project leader
(data quality, data collection,
•
HIM Director
and data retrieval)
•
Vice President, Finance
•
Programmer
•
Vice President, Nursing
•
Vendor
•
Director, Materials Management
Training Committee
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Section 7 Project and Operations Management 527
•
Director, Research
•
Systems analyst
•
Database administrator
Development Committee
•
Project leader
(programming and
•
Vice President, Clinical Services
customization)
•
Chief Information Officer
•
Programmer
•
Vendor
•
Systems analyst
•
Database administration
•
Project leader
•
HIM Director
•
Director, Lab
•
Programmer
•
Vendor
•
Systems analyst
•
Database administrator
•
Project leader
•
Director, Radiology
•
Programmer
•
Vendor
•
Systems analyst
Conversion Committee
Interfaces Committee
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Section 7 Project and Operations Management 528
•
Database administrator
© 2014 Cengage Learning ®. All Rights Reserved.
2. Why did you choose them? The students do not need to make choices on an individual basis but rather on overall philosophy. Each subcommittee has a project leader so that he or she provides continuity to the project. Each committee also should have someone at least at a director level to provide a management perspective. At least 1 information system staff should be on each subcommittee, with some subcommittees having multiple representatives. A vendor is included in each subcommittee because he or she can provide information on the system and on how it has been done at other sites. 3. What charge would you give to each subcommittee? All subcommittees would be responsible for reporting progress and issues at each full committee meeting. Each subcommittee would be responsible for bringing in others as needed to complete the job. For example, the training subcommittee may want to bring in users who will be trainers. Suggested subcommittees and their respective responsibilities are shown in Table 7-15B.
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Section 7 Project and Operations Management 529
Table 7-15B Suggested Subcommittees and Tasks
Suggested Subcommittees and Tasks Subcommittee
Tasks
Training
•
Develop training plan
•
Conduct the training
•
Evaluate the training
Data Management
•
Build data quality into system
(data quality, data collection,
•
Build tables
and data retrieval)
•
Get users involved in process
•
Develop routine reports
•
Design screens
Development
•
Develop program software
(programming and
•
Develop testing plan
customization)
•
Test system
•
Customizing settings
•
Determine what needs to be brought over from the old
Conversion
system to the new system •
Determine what data need to be converted and what can be transferred without manipulation
Interfaces
•
Develop conversion plan
•
Test conversion
•
Determine interface needs
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Section 7 Project and Operations Management 530
•
Develop interface
•
Determine conversion needs
•
Test interfaces
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References Johns Liebler and McConnell
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Section 7 Project and Operations Management 531
CASE 7-16 Committee to Perform System Benefits Analysis
Questions and Suggested Answers 1. What benefits can be achieved with the implementation of an EHR for the HIM Department? •
Elimination of paper records system and its inefficiencies
•
Greater privacy and security controls
•
No lost charts
•
Focus on management of information, not paper
2. Which benefits might impact the delivery of patient care? •
Reduce medical errors
•
Faster access to PHI
•
Reduce/eliminate duplicate tests.
•
Ability to share information with other healthcare providers, insurers, and other authorized users
•
Improve the quality of care
References Abdelhak LaTour and Eichenwald-Maki
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Section 7 Project and Operations Management 532
CASE 7-17 Project Management and Program Evaluation Review Technique (PERT) Chart
Questions and Suggested Answers 1. What is the critical path? Identify disposition of charts, set budget, gain approval, obtain resources, and purge files. 2. What problems can you identify? You only have allowed 14 days to purge the files. This may not be enough time to complete the purge. 3. How can you improve on this plan? The first thing is to perform a time study to give you a clear picture of how long it will take realistically. Then, if necessary, you can plan for more time to complete the project. Your next draft may need more details, such as the resources to be obtained or contract negotiation if you hire someone to purge and/or destroy the records.
References Abdelhak LaTour and Eichenwald-Maki
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Section 7 Project and Operations Management 533
CASE 7-18 Project Management and Analysis of a Gantt Chart
Questions and Suggested Answers How can the Gantt chart be improved? The steps that are shown in the Gantt chart are a good start; however, they are just the basics. There needs to be more detail for the project plan. As an example, one of the steps is to develop screens. This is assigned to a programmer. There should also be a step for screen design that would be done by the users. The programmer would then step in and do the programming. The predecessors are appropriate. Some of the employees given the responsibility of the task could be improved. The CIO is in charge of the site preparation. This should be a maintenance operation. Also, the project manager is in charge of setting configuration. This task would be more appropriate for a system analyst or other technical person who, of course, would need input from the users. It would be difficult to determine if the amount of time allocated is appropriate until the Gantt chart shows the additional steps necessary to complete the project. Even then, it would be difficult for the students to determine if the amount of time allotted was appropriate unless the chart was grossly off.
References Abdelhak LaTour and Eichenwald-Maki
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Section 7 Project and Operations Management 534
CASE 7-19 Creating a Gantt Chart
Questions and Suggested Answers You have been asked to create a first draft of a Gantt chart for the implementation process. An example of a Gantt chart is provided in Figure 7-19A.
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Section 7 Project and Operations Management 535
Figure 7-19A Gantt Chart (Page 1)
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Section 7 Project and Operations Management 536
Figure 7-19A Gantt Chart (Page 2) © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 7 Project and Operations Management 537
Figure 7-19A Gantt Chart (Page 3)
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Section 7 Project and Operations Management 538
Figure 7-19A Gantt Chart (Page 4)
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Section 7 Project and Operations Management 539
Figure 7-19A Gantt Chart (Page 5)
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Section 7 Project and Operations Management 540
Figure 7-19A Gantt Chart (Page 6)
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Section 7 Project and Operations Management 541
Figure 7-19A Gantt Chart (Page 7) © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 7 Project and Operations Management 542
References Abdelhak LaTour and Eichenwald-Maki
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Section 7 Project and Operations Management 543
CASE 7-20 Evaluation of Project Management Budget Variance Your hospital has a major problem with duplicate medical record numbers. You are implementing a new EHR and need to get this problem solved before implementation. You decide to hire a consultant to act as the project manager and to use temporary staff to do the actual work. The use of temporary staff is at the suggestion of the consultant. You have to train the registration staff on ways to avoid creating duplicate medical record numbers. Some of the temporary staff members have to be trained to pull and file charts. Other temporary staff members are trained to review the charts and determine if there is a duplicate and combine the physical chart where appropriate. A temporary Registered Health Informatin Administator (RHIA) is responsible for conducting data quality checks. You have a significant amount of temporary staff turnover, resulting in constant training and fluctuation of productivity on a daily basis. This results in the RHIA having to do a 100% audit for the entire project, instead of just at the beginning as planned. You really have had to speed up the process the last 2 months to complete the project on time. The project is completed 2 days ahead of time; the quality of the work is great. Now you need to review the final budget for the MPI clean-up.
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Section 7 Project and Operations Management 544
Table 7-5
Master Patient Index (MPI) Clean-Up Budget MPI Clean-Up Budget Actual Monthly Expenses
Line Item
April
Temp Staff
12,345.44 13,764.45 21,546.63 24,454.44
Equipment
May
June
July
Budgeted
Actual
Variance
60,000.00 72,110.96 (12,110.96)
602.67
0
0
0
1,000.00
602.67
397.33
5,000.00
5,000.00
5,000.00
5,000.00
20,000.00
20,000.0
0
Training
2,000.00
1,200.00
300.00
300.00
3,000.00
3,800.00
(800.00)
Total
19,948.11 19,964.45 26,846.63 29,754.44
Project Manager
84,000.00 96,513.63 (12,513.63)
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Questions and Suggested Answers 1. Based on the project description and the budget shown in Table 7-5, what problems do you see? Both the temporary staffing and the training are substantially over budget for the project. 2. From a project management standpoint, what could have been done to make this project work better? The staffing needed to be more stable. Because of the instability, you lost a lot of productivity from the RHIA, who could have been better utilized. 3. To what do you contribute the budget variance? The excessive turnover required additional training not included in the budget. Also, the RHIA had to do 100% review of the charts for the entire project—not just the beginning as planned. This required many extra hours. All of the problems resulted in forced overtime at the end of the project. 4. Does the budget reflect the description of the project? No. The project was successful in that the clean-up was completed on time and with good quality results. The budget was over $12,513.63, which looks like there were problems. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 7 Project and Operations Management 545
5. If you had to do this again, what would you do differently? It would have been more cost effective to spend a little more per hour to get stable employees rather than the less-expensive temporary workers. This would allow you to use the RHIA more effectively than the 100% audit.
References Abdelhak Johns LaTour and Eichenwald-Maki
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Section 7 Project and Operations Management 546
CASE 7-21 Developing a Filing System and Evaluating Equipment Needs
Questions and Suggested Answers You are developing a filing system and determining the number of shelves and the like that you will need for the new hospital. The students have a lot of flexibility. They should specify what they recommend and justify their decision. They should also specify what they would do to address any advantages and disadvantages of the system chosen. The samples below are not comprehensive but will provide ideas on what the student should document. 1. Determine the following. 2. Justify your decisions. Include the advantages and disadvantages of the system that you select, where appropriate. 3. Identify how you will work around the disadvantages of the system, where appropriate. •
Amount of filing space required: 93,750 linear inches o (25,000 + 28,000 + 32,000 + 40,000 = 125,000 charts) × 0.75 = 93,750
•
Type of shelving desired: The student should recommend open shelving or mobile shelving. o Advantages of open shelving are ease of use and ability to get multiple file clerks in files at same time. o The disadvantage of open shelving is the amount of space that it consumes. There is little that can be done to overcome the space issue with open shelving—either you have it or you do not. You can design the arrangement of the shelving unit to maximize the space, such as placing the units back to back. o The advantage of mobile shelving is the reduction in floor space.
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Section 7 Project and Operations Management 547
o The disadvantage of mobile shelving is that you cannot get as many people in the file system at the same time. To allow more people in the mobile shelving, an option is to place a few stationary shelves to allow for more aisles. •
Number of shelves per unit: Students should address both the width and the number of shelves. o Students could choose anywhere from 5 to 9 shelves, but 8 is a very common number because it maximizes space but most people can still reach the top shelf to pull a chart. o The most likely width of the shelving unit ranges from 30 to 36 inches.
•
Number of shelving units required: The student’s calculation will depend on the selections above. An example would be as follows: o 36 inches wide 8 shelves = 288 linear filing inches per unit: 93,750/288 = 325.52 = 326 units
•
Number of guides required o Based on filing standards, there should be 10,000 guides. o If outguides will be used: Students can choose either option. o Outguides are great for filing loose material when the chart is checked out but staff frequently do not take the time to take loose material out of the outguide and file in the chart when the chart is returned to the file. o Management would have to monitor compliance the policy. o They would also have to ensure that an adequate number of outguides are available.
•
Type of filing system to be used (centralized, decentralized, terminal digit, alphabetic, and so on): o The student needs to choose between centralized and decentralized file system.
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Section 7 Project and Operations Management 548
o Centralized provides more control and requires less staff. It just may not be as customer service focused since everything is done through a central department. o A decentralized file system requires more management staff, more staff, and is more difficult to maintain. Because charts are closer to the users, there could be improvement in customer service. o Students should also determine if an alphabetic or numeric system should be utilized. Given the information in the case study, the student should select a numbering system. Terminal digit appears to be the most common numbering system utilized. o To accommodate a decentralized format, the budget would have to be increased in order to hire the staff needed. o To manage a centralized system, there has to be an efficient manner of getting medical records to the requestor. Due to the volume, they should choose a numeric filing system such as terminal digit. Terminal digit filing takes longer to train staff than alphabetic, but it provides an even distribution of charts. The additional training time is insignificant, since someone can learn terminal digit filing in a very short time. •
Method used to get information from HIM Department to the requestor: Nothing in the case study indicates that imaging or EHR is an option, so the student should assume that the processes are manual. Options include the following: o Delivery staff o Asking requestors to come get the charts they requested o Fax o Dumbwaiters or pneumatic tubes None of these is ideal. Typically, charts are either delivered or picked up by a staff member. This can be expensive and slow. There would need to be backups in place to help in peak times or when the appropriate staff are unavailable.
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Section 7 Project and Operations Management 549
•
Type of equipment needed to file and retrieve records: Typical equipment required is as follows: o Supplies to repair charts o Tables to sort charts o Shelving units for charts to be placed in until filed o Carts for transporting files
•
Method of chart location system: Electronic chart location system would be the only viable choice, given the number of charts.
•
If outguides will be used: The student may answer either to use outguides or just to use the electronic chart location system to lotcate charts not on the shelf.
•
Security measures to be taken: o Only authorized staff should be allowed in the area. o Charts should not be removed from the area without the chart being checked out. o The file area should be behind locked doors. The doors can be to the entire HIM Department or specifically to the file area or both.
•
Design of medical record folder: In designing the folder students should include the following: o Paper size and weight: The typical paper is manila 11–14 point weight. o Printing: The printing should include the following: o Name of the facility o Barometer (or year band)
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Section 7 Project and Operations Management 550
o Medical record number: The medical record number should also be printed o Barcode o Color coding: Color coding should be used on the edges of the folder. Student should recommend color coding because it is a valuable tool in preventing and identifying misfiles. It can also be used in the sorting process. o The front of the chart should be scored for flexibility of the folder o The spine should be reinforced to keep it from tearing when the chart is repeatedly pulled and filed. o Rules for the medical record. Examples: “Leave in plain sight” and “Do not remove from facility without permission.”
References Davis and LaCour Green and Bowie Johns LaTour and Eichenwald-Maki
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Section 7 Project and Operations Management 551
CASE 7-22 Project Planning for Conversion from Alphabetic to Terminal Digit Filing
Questions and Suggested Answers You work in a physician office as the office manager. Several new physicians have been added to the practice over the past year. There are approximately 32,000 records. Based on time and motion studies, 1 employee can convert 50 records from alphabetical to terminal digit filing in an hour. The alphabetic filing system is no longer working for your office. Your job is to plan the conversion from alphabetic to terminal digit filing.
Create a plan for this conversion that includes: •
Number of staff: There are 32,000 charts to be converted and each staff can do 100 per hour. This would require 320 hours. If you want the project to be completed in 20 hours, then you would need 16 people converting the charts. In addition to these staff members, you will need staff members to bring charts to the conversion staff members and to file them back. No figures are provided to determine this number of staff members; students can recommend the number based on their assumptions. An example of an assumption could be that you use a combination of temporary and permanent staff or that you use permanent staff only. The student probably will recommend 2–3 staff members.
•
Space: The process needs to be done close to the file area to facilitate movement of records between the conversion staff and the transfer staff. There will need to be adequate space to allow worktables for the staff, for supplies, and for carts of records. There will also need to be space for charts to be sorted prior to being filed.
•
Supplies required: They include new folders with the medical record number preprinted and carts for use in transporting charts between shelving.
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Section 7 Project and Operations Management 552
•
Staff training required: Staff members need to know exactly what is expected of them both in terms of procedure and productivity. They need to be trained prior to the start of the project, so that they can begin immediately with the conversion. They also need to know the flow of the process so that they understand how their actions impact others in the project. The staff needs to be broken into various teams—those that retrieve charts, convert, and file charts.
•
Time schedule: The project has to be done over the weekend so that it is completed before it impacts patient care. There may be straggler charts that will have to be completed over the days and weeks to come, but the bulk needs to be completed before the office opens Monday morning. The number of hours scheduled for the work should not be too long, because the staff will tire and not be as productive. Sample hours are as follows: Friday 6:00 p.m. to 10:00 p.m. Saturday 8:00 a.m. to 5:00 p.m. Sunday 8:00 a.m. to 5:00 p.m. All the employees on the project team need to have breaks and lunch at the same time to facilitate the even flow of the project. To ensure they are all back on time, you may want to feed them on-site to eliminate travel so they are able to stay on schedule.
•
The process that will be followed: The steps in the process are as follows:
1. Charts are pulled from the alphabetic filing system. 2. The paperwork is removed from the old folder and placed in the prenumbered folder. 3. The MPI is updated to reflect the medical record number. 4. The folders are sorted into terminal digit order. 5. Charts are filed into strict terminal digit order.
Reference LaTour and Eichenwald-Maki © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 7 Project and Operations Management 553
CASE 7-23 Planning the Health Information Management (HIM) Department for a New Facility
Questions and Suggested Answers Use data in Table 7-6 to determine number of employees needed, their job titles, and their job descriptions. The students have a lot of flexibility in this case study. All tasks and all positions are not necessarily included. The positions are the most common ones. Also, the tasks are the main ones that take up the employees’ time. There may be other tasks not included in the calculations. •
Determine number of employees needed and the job title of each. o Transcriptionists: 11.25 FTE 7,000,000 number of lines to be transcribed/300 hours = 23,333 hours required. 23,000/2,080 hours in working year = 11.21 FTE o Inpatient coder: 3 FTE 25,000 discharges 15 minutes per chart = 375,000 minutes required to process. 375,000/124,800 minutes in working year = 3.04 FTE o Outpatient coder: 1.5 FTE (57,000 outpatients + 36,000 ER) 2 minutes each = 186,000 minutes required 186,000/124,800 = 1.49 FTE o Inpatient analyst: 5 FTE (25,000 10 = 250000 minutes to assemble) + (25,000 15 = 375000 minutes to analyze) 625,000 total of minutes to assemble and analyze charts 625,000 = 5.01 FTE 124,800 minutes in working year
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Section 7 Project and Operations Management 554
o Outpatient analyst: 2 FTE (57,000 + 57,000) 2 = 228,000 total minutes to assemble and analyze charts. 228, 00 124, 800 number of minutes in work year = 1.83 FTE
o Tumor registrar: Abstracting is only 1 part of the Tumor Registry role. They also do case finding, tumor conference, tumor committee, and so on: 0.07 FTE 145 1 hour = 145 hours per year 145 2, 080 = 0.07 FTE
o File clerk—charts: 5 FTE 300,000 2 = 600,000 600, 000 124, 800 = 4.8 FTE
o File clerk—loose material: 1.5 FTE 800 pages per day 5 days a week = 4,000 pages a week 4,000 48 weeks = 192,000 pages a year 250, 000 192, 000 = 1.3 FTE
o Release of information coordinator: 0.75 FTE 3,000 30 = 90,000 minutes to process requests 90, 000 124, 800 minutes in year = 0.75 FTE
o Birth certificate coordinator: 0.5 FTE 900 60 = 54,000 54, 000 124, 800 = 0.43 FTE © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Section 7 Project and Operations Management 555
o Director, HIM—1 o Supervisor, HIM—The students have some flexibility here. They could opt for another layer of management and include assistant director(s). One example would be to have a supervisor over the following: transcription, file area, coding, assembly/analysis, coding, and research/birth certificate. The students have a lot of flexibility with these jobs. They could also separate the supervisor position into several supervisor positions: supervisor of coding, supervisor of transcription, and so on. They could also combine the 2 file clerk position into 1 with 6.5 FTEs. Examples of what job descriptions for each of these positions could look like are shown in
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Figures 7-23A through 7-23L.
Figure 7-23A Job Description for HIM Director
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Section 7 Project and Operations Management 556
© 2014 Cengage Learning ®. All Rights Reserved.
Figure 7-23B Job Description for HIM Supervisor
Figure 7-23C Job Description for Transcriptionist
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Section 7 Project and Operations Management 557
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Figure 7-23D Job Description for Inpatient Coder
Figure 7-23E Job Description for Outpatient Coder © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
© 2014 Cengage Learning ®. All Rights Reserved.
. Figure 7-23F Job Description for Inpatient Analyst
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Section 7 Project and Operations Management 558
Figure 7-23G Job Description for Outpatient Analyst
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Section 7 Project and Operations Management 559
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Figure 7-23H Job Description for Tumor Registrar
Figure 7-23I Job Description for File Clerk–Charts
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Section 7 Project and Operations Management 560
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Figure 7-23J Job Description for File Clerk–Loose Material
Figure 7-23K Job Description for Release of Information Coordinator
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Section 7 Project and Operations Management 561
Figure 7-23L Job Description for Birth Certificate Coordinator
References Abdelhak American Health Information Management Association (AHIMA) Davis and LaCour Green and Bowie Johns LaTour and Eichenwald-Maki
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Section 7 Project and Operations Management 562
CASE 7-24 Planning Release of Information (ROI) Department Functions for a New Facility You have been hired as the director of HIM for a new 100-bed hospital that opens 6 months from now. As part of the planning for the HIM Department you are responsible for designing the ROI functions from the ground up. Write a detailed proposal to the hospital administrator outlining what functions must be performed, why they must be included, and what needs to be done to prepare for the implementation of the ROI desk.
Questions and Suggested Answers Expectations are that you will average five 5 requests per day for medical information during the first 6 months, and after that you expect 15 requests per day. Examples of each area are provided. The student may come up with many more. You are not expected to conduct the development, just the planning. Be specific in developing your plan. For example, list all of the policies and procedures that must be written and forms that must be designed. You do not actually have to write policies and procedures, design the forms, and so on. Tasks should include, but not be limited to the following: •
Policy and procedure: There needs to be policy and procedures on all functions (valid authorization, processing request, what to do when unclear, depositing revenue, how to handle any and all requests, notifying risk management of potential issues, customer service issues, who needs to sign authorization, how to handle requests for records/media stored elsewhere, faxing records, alcohol and drug records, psychiatric records), productivity requirements, documentation, quality standards, copy charges, turnaround times, and so on.
•
Equipment required:
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Section 7 Project and Operations Management 563
Release of information system, copy machine, fax machine, office furniture, carts, postage scale, office supplies including forms, paper, toner, envelopes, and the like. •
Training: There need to be training materials, policies and procedures, trainer, scenarios for staff to work through, release of information system, and so on.
•
Form design: Many of them will be form letters that can come from the ROI system. These letters will include one notifying the requester that you do not have records on the patient or that the authorization is valid or missing. You will also need a valid authorization form and productivity forms. You may also want to have a valid authorization checklist.
•
Information systems: You will need the release of information system that is linked to the MPI to automatically populate the system. The ROI staff will also need access to the chart locator so they can find the chart to pull it for copying.
•
Management systems: The system can also generate invoices, receipts, and deposits. You will need monitoring in place not only of productivity but also of quality, statistics, and tracking of revenue (money and deposits).
•
Other: Calculate the number of staff members needed.
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Section 7 Project and Operations Management 564
References Davis and LaCour Johns LaTour and Eichenwald-Maki
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Section 7 Project and Operations Management 565
References Abdelhak, M., Grostick, S., Hanken, M. A., & Jacobs, E. (2012). Health information: Management of a strategic resource (3rd ed.). Philadelphia: W.B. Saunders. American Health Information Management Association (AHIMA). (n.d.). Sample job descriptions. Retrieved on January 11, 2013, from http://www.ahima.org/ehim/roles.aspx http://library.ahima.org/xpedio/idcplg?IdcService=GET_SEARCH_RESULTS&QueryText=xPubli shSite<substring>`BoK`<and>xSource<contains>`Job%20Description`&SearchProviders=mast er_on_ch1as13&ftx=&AdvSearch=True&adhocquery=1&urlTemplate=/xpedio/groups/public/d ocuments/web_assets/queryresults.hcsp&ResultCount=25&SortField=xPubDate&SortOrder=D esc Davis, N., & LaCour, M. (2002). Introduction to health information technology. Philadelphia: W.B. Saunders. Green, M. A., & Bowie, M. J. (2005). Essentials of health information management: Principles and practices. Clifton Park, NY: Thomson Delmar Learning. Johns, M. (2011). Health information management technology: An applied approach (3rd ed.). Chicago: American Health Information Management Association (AHIMA). LaTour, K., & Eichenwald-Maki, S. (2010). Health information management: Concepts, principles and practice (3rd ed.). Chicago: American Health Information Management Association (AHIMA). Libeler, J., & McConnell, C. (2012). Management principles for health professionals (6th ed.). Sudbury, MA: Jones and Bartlett Learning.
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
CASE 2-25 Medicare-Severity Diagnosis-Related Group (MS-DRG) Comparisons Your chief financial officer (CFO) has asked you to gather some information for him. He wants to compare the average length of stay (ALOS), average charges, and average reimbursement for specific MS-DRGs at your facility to the geometric mean length of stay and determine if there are any statistically significant differences at the 0.5 level.
1.
Identify the MS-DRG geometric mean length of stay for the MS-DRGs in Table 2-8 to the average total day in Table 2-11. Compare the two figures. Determine if the difference between them is statistically significant.
2.
Determine the national average charges information for the MS-DRGs in Table 2-11 and compare it to the local data using Table 2-9. Determine if the difference between them is statistically significant.
3.
Determine the average reimbursement data for the MS-DRGS in Table 2-10. The national data can be found in Table 2-11. Compare the 2 figures. Determine if the difference between them is statistically significant
4.
Complete Tables 2-8 through 2-10 and write a memo to the CFO describing your findings.
Table 2-8 Geometric Mean Length of Stay (GMLOS)
Average LOS Medicare-Severity
Patient
Diagnosis Related
ALOS
Geometric
Statistically
Mean LOS
Significant
5.2
No
5.6
No
3.9
No
5.2
No
Group 4.6 6.4 061
5.9 5.7 5.0 5.6 6.8
062
4.2 5.8 5.0 3.1 2.7
063
3.4 3.3 3.9 4.2 4.3
088 5.4 5.1
4.1 3.1
3.5
No
3.0 089
2.7 3.0 2.6
Table 2-9 Average Charges Average Charges MS-Diagnosis-Related
Hospital Charges
Statistically National
Group
by Patient $74,842
Significant $74,205
No
$50,187
No
$41,515
No
$70,565 061
$68,555 $75,563 $69,441 $51,235 $50,889
062
$50,985 $51,224 $53,684 $40,789
063 $38,220
$37,500 $41,885 $35,687 $40,210
$39,880
No
$26,390
Yes
$39,852 088
$38,005 $34,236 $40,568 $23,100 $20,001
089
$20,211 $19,150 $23,105
Table 2-10 Average Reimbursements Average Reimbursements Hospital MS-Diagnosis-
Statistically Reimbursement by
National
Related Group
Significant Patient $14,564
061
$15,556 $13,556
$15,972
No
$14,665 $12,556 $7,900
$10,020
No
$7,186
No
$7,658
No
$4,343
No
$8,952 062
$8,556 $8,554 $8,548 $8,425 $7,054
063
$7,055 $8,156 $8,554 $6,521 $7,685
088
$7,258 $7,885 $6,255 $4,753 $4,024
089
$4,358 $4,123 $4,025
Table 2-11 Medicare Provider Analysis and Review (MEDPAR) 2010 Diagnosis-Related Groups Centers for Medicare and Medicaid services 100% MEDPAR Inpatient Hospital National Data for Fiscal Year 2010 Short Stay Inpatient Diagnosis-Related Groups MSDRG 061 062 063 088 089
Total Charges $233,301,461 $227,498,941 $72,775,862 $52,123,005 $92,022,041
Covered Charges $231,801,852 $225,539,528 $72,224,663 $51,635,662 $90,873,741
Medicare Reimbursement $50,216,062 $45,424,709 $12,597,821 $10,009,231 $15,145,663
Total Days 25,900 25,473 6,892 6,832 12,051
Number of Discharges 3,144 4,533 1,753 1,307 3,487
Average Total Day 8.2 5.6 3.9 5.2 3.5
Case Study Crosswalk for Baccalaureate Degree Curriculum Competencies Domain 1 Domain 2 Domain 3 Domain 4 Domain 5 Health Statistics, Biomedical Research, and Health Services Information Organization Quality Organization Technology and Health Data Management and Delivery and Systems Management Management Case Section 1 Case 1‐1 Case 1‐2 Case 1‐3 Case 1‐4 Case 1‐5 Case 1‐6 Case 1‐7 Case 1‐8 Case 1‐9 Case 1‐10 Case 1‐11 Case 1‐12 Case 1‐13 Case 1‐14 Case 1‐15 Case 1‐16 Case 1‐17 Case 1‐18 Case 1‐19 Case 1‐20 Case 1‐21 Case 1‐22 Case 1‐23 Case 1‐24 Case 1‐25 Section 2 Case 2‐1 Case 2‐2 Case 2‐3 Case 2‐4 Case 2‐5 Case 2‐6 Case 2‐7 Case 2‐8 Case 2‐9 Case 2‐10
X X X X X X X X X X X X X X X X X X X X X
X X X X X X X X X X X X X X X X X X
X X
X X X X X X X X X X
X X X X X X X X X X X X X X X X X X
X X
X X
X X
X X X X X X
X X
X X X X
X X X X X X
X X X X
X X X X X X X
X
X X X X X
X
X X X X X X X X X X
Domain 1
Case 2‐11 Case 2‐12 Case 2‐13 Case 2‐14 Case 2‐15 Case 2‐16 Case 2‐17 Case 2‐18 Case 2‐19 Case 2‐20 Case 2‐21 Case 2‐22 Case 2‐23 Case 2‐24 Case 2‐25 Case 2‐26 Case 2‐27 Case 2‐28 Case 2‐29 Case 2‐30 Case 2‐31 Case 2‐32 Case 2‐33 Case 2‐34 Case 2‐35 Case 2‐36 Case 2‐37 Case 2‐38 Case 2‐39 Case 2‐40 Case 2‐41 Case 2‐42 Case 2‐43 Case 2‐44 Case 2‐45 Case 2‐46 Case 2‐47
Health Data Management X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X
Section 3 Case 3‐1
X
Domain 2 Domain 3 Domain 4 Health Statistics, Biomedical Research, and Health Services Information Quality Organization Technology Management and Delivery and Systems X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X
X X X
X
X X X
Domain 5
Organization and Management X X X X X
X
X X
Domain 1
Case 3‐2 Case 3‐3 Case 3‐4 Case 3‐5 Case 3‐6 Case 3‐7 Case 3‐8 Case 3‐9 Case 3‐10 Case 3‐11 Case 3‐12 Case 3‐13 Case 3‐14 Case 3‐15 Case 3‐16 Case 3‐17 Case 3‐18 Case 3‐19 Case 3‐20 Case 3‐21 Case 3‐22 Case 3‐23 Case 3‐24 Case 3‐25 Case 3‐26 Case 3‐27 Case 3‐28 Case 3‐29 Case 3‐30 Case 3‐31 Case 3‐32 Case 3‐33 Section 4 Case 4‐1 Case 4‐2 Case 4‐3 Case 4‐4 Case 4‐5 Case 4‐6
Health Data Management X X X X X X X X X
Domain 2 Domain 3 Domain 4 Health Statistics, Biomedical Research, and Health Services Information Quality Organization Technology Management and Delivery and Systems X X X X X X X X X X X X X X X X X X X X X X X X X X X
Domain 5
Organization and Management
X
X X
X X X X X X X X X X X X X X X X X
X X
X X X X X
X
X X X
X X X X
X X X X X X
Domain 1
Health Data Management Case 4‐7 Case 4‐8 Case 4‐9 Case 4‐10 Case 4‐11 Case 4‐12 Case 4‐13 Case 4‐14 Case 4‐15 Case 4‐16 Case 4‐17 Case 4‐18 Case 4‐19 Case 4‐20 Case 4‐21 Case 4‐22 Case 4‐23 Case 4‐24 Case 4‐25 Case 4‐26 Case 4‐27 Case 4‐28 Case 4‐29 Case 4‐30 Case 4‐31 Case 4‐32 Case 4‐33 Case 4‐34 Case 4‐35 Case 4‐36 Case 4‐37 Case 4‐38 Case 4‐39 Section 5 Case 5‐1 Case 5‐2 Case 5‐3 Case 5‐4 Case 5‐5
Domain 2 Domain 3 Domain 4 Health Statistics, Biomedical Research, and Health Services Information Quality Organization Technology Management and Delivery and Systems X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X
X X X X X
Domain 5
Organization and Management
X X X X
X
Domain 1
Health Data Management Case 5‐6 Case 5‐7 Case 5‐8 Case 5‐9 Case 5‐10 Case 5‐11 Case 5‐12 Case 5‐13 Case 5‐14 Case 5‐15 Case 5‐16 Case 5‐17 Case 5‐18 Case 5‐19 Case 5‐20 Case 5‐21 Case 5‐22 Case 5‐23 Case 5‐24 Case 5‐25 Case 5‐26 Case 5‐27 Case 5‐28 Case 5‐29 Case 5‐30 Case 5‐31 Case 5‐32 Case 5‐33 Case 5‐34 Case 5‐35 Case 5‐36 Case 5‐37 Case 5‐38 Case 5‐39 Case 5‐40 Case 5‐41 Case 5‐42 Case 5‐43 Case 5‐44 Case 5‐45
Domain 2 Domain 3 Domain 4 Health Statistics, Biomedical Research, and Health Services Information Quality Organization Technology Management and Delivery and Systems X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X
Domain 5
Organization and Management
Domain 1
Health Data Management Case 5‐46 Case 5‐47 Case 5‐48 Case 5‐49 Case 5‐50 Case 5‐51 Case 5‐52 Case 5‐53 Case 5‐53 Case 5‐54 Case 5‐55 Case 5‐56 Section 6 Case 6‐1 Case 6‐2 Case 6‐3 Case 6‐4 Case 6‐5 Case 6‐6 Case 6‐7 Case 6‐8 Case 6‐9 Case 6‐10 Case 6‐11 Case 6‐12 Case 6‐13 Case 6‐14 Case 6‐15 Case 6‐16 Case 6‐17 Case 6‐18 Case 6‐19 Case 6‐20 Case 6‐21 Case 6‐22 Case 6‐23 Case 6‐24 Case 6‐25 Case 6‐26
Domain 2 Domain 3 Domain 4 Health Statistics, Biomedical Research, and Health Services Information Quality Organization Technology Management and Delivery and Systems X X X X X X X X X X X X
X X
X X
X
X X
X
X
X X
X X
X
Domain 5
Organization and Management X
X X X X X X X X X X X X X X X X X X X X X X X X X X
Domain 1
Case 6‐27 Case 6‐28 Case 6‐29 Section 7 Case 7‐1 Case 7‐2 Case 7‐3 Case 7‐4 Case 7‐5 Case 7‐6 Case 7‐7 Case 7‐8 Case 7‐9 Case 7‐10 Case 7‐11 Case 7‐12 Case 7‐13 Case 7‐14 Case 7‐15 Case 7‐16 Case 7‐17 Case 7‐18 Case 7‐19 Case 7‐20 Case 7‐21 Case 7‐22 Case 7‐23 Case 7‐24
Health Data Management
Domain 2 Domain 3 Domain 4 Health Statistics, Biomedical Research, and Health Services Information Quality Organization Technology Management and Delivery and Systems
X
X
X X X X
X X X X X
X
X X X X X
X X X X
X X X
X X X X
X X X X X X X X X
X
X X
X X X X
X
X
X
X
X
Domain 5
Organization and Management X X X
X X X X X X X X X X X X X X X X X X X X X X X X
Case Study Crosswalk for Associate Degree Curriculum Competencies Domain 1 Domain 2 Domain 3 Domain 4 Domain 5 Health Statistics, Biomedical Research, and Health Services Information Organization Quality Organization Technology and Health Data Management and Delivery and Systems Management Management Case Section 1 Case 1‐1 Case 1‐2 Case 1‐3 Case 1‐4 Case 1‐5 Case 1‐6 Case 1‐7 Case 1‐8 Case 1‐9 Case 1‐10 Case 1‐11 Case 1‐12 Case 1‐13 Case 1‐14 Case 1‐15 Case 1‐16 Case 1‐17 Case 1‐18 Case 1‐19 Case 1‐20 Case 1‐21 Case 1‐22 Case 1‐23 Case 1‐24 Case 1‐25 Section 2 Case 2‐1 Case 2‐2 Case 2‐3 Case 2‐4 Case 2‐5 Case 2‐6 Case 2‐7 Case 2‐8 Case 2‐9 Case 2‐10
X X X X X X X X X X X X X X X X X X X X X
X X X X X X X X X X X X X X X X X X
X X
X X X X X X X X X X
X X X X X X X X X X X X X X X X X X
X X
X X
X X
X X X X X X
X X
X X X X
X X X X X X
X X X X
X X X X X X X
X
X X X X X
X
X X X X X X X X X X
Domain 1
Case 2‐11 Case 2‐12 Case 2‐13 Case 2‐14 Case 2‐15 Case 2‐16 Case 2‐17 Case 2‐18 Case 2‐19 Case 2‐20 Case 2‐21 Case 2‐22 Case 2‐23 Case 2‐24 Case 2‐25 Case 2‐26 Case 2‐27 Case 2‐28 Case 2‐29 Case 2‐30 Case 2‐31 Case 2‐32 Case 2‐33 Case 2‐34 Case 2‐35 Case 2‐36 Case 2‐37 Case 2‐38 Case 2‐39 Case 2‐40 Case 2‐41 Case 2‐42 Case 2‐43 Case 2‐44
Health Data Management X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X
Section 3 Case 3‐1 Case 3‐2 Case 3‐3 Case 3‐4
X X X X
Domain 2 Domain 3 Domain 4 Health Statistics, Biomedical Research, and Health Services Information Quality Organization Technology Management and Delivery and Systems X X X X X X X X X X X X X X X X X
Domain 5
Organization and Management X X X X X
X
X
X X X
X X X X
X X
Domain 1
Case 3‐5 Case 3‐6 Case 3‐7 Case 3‐8 Case 3‐9 Case 3‐10 Case 3‐11 Case 3‐12 Case 3‐13 Case 3‐14 Case 3‐15 Case 3‐16 Case 3‐17 Case 3‐18 Case 3‐19 Case 3‐20 Case 3‐21 Case 3‐22 Case 3‐23 Case 3‐24 Case 3‐25 Case 3‐26 Case 3‐27 Case 3‐28 Case 3‐29 Case 3‐30 Case 3‐31 Case 3‐32 Case 3‐33 Section 4 Case 4‐1 Case 4‐2 Case 4‐3 Case 4‐4 Case 4‐5 Case 4‐6 Case 4‐7 Case 4‐8 Case 4‐9
Health Data Management X X X X X X
Domain 2 Domain 3 Domain 4 Health Statistics, Biomedical Research, and Health Services Information Quality Organization Technology Management and Delivery and Systems X X X X X X X X X X X X X X X X X X X X X X
Domain 5
Organization and Management
X
X X
X X X X X X X X X X X X X X X X X
X X
X X X X X
X
X X X
X X X X
X X X X X X X X X
Domain 1
Health Data Management Case 4‐10 Case 4‐11 Case 4‐12 Case 4‐13 Case 4‐14 Case 4‐15 Case 4‐16 Case 4‐17 Case 4‐18 Case 4‐19 Case 4‐20 Case 4‐21 Case 4‐22 Case 4‐23 Case 4‐24 Case 4‐25 Case 4‐26 Case 4‐27 Case 4‐28 Case 4‐29 Case 4‐30 Case 4‐31 Case 4‐32 Case 4‐33 Case 4‐34 Case 4‐35 Case 4‐36 Case 4‐37 Case 4‐38 Case 4‐39 Section 5 Case 5‐1 Case 5‐2 Case 5‐3 Case 5‐4 Case 5‐5 Case 5‐6 Case 5‐7 Case 5‐8
X
Domain 2 Domain 3 Domain 4 Health Statistics, Biomedical Research, and Health Services Information Quality Organization Technology Management and Delivery and Systems X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X
X X X X X X X X
Domain 5
Organization and Management X X X
X
Domain 1
Health Data Management Case 5‐9 Case 5‐10 Case 5‐11 Case 5‐12 Case 5‐13 Case 5‐14 Case 5‐15 Case 5‐16 Case 5‐17 Case 5‐18 Case 5‐19 Case 5‐20 Case 5‐21 Case 5‐22 Case 5‐23 Case 5‐24 Case 5‐25 Case 5‐26 Case 5‐27 Case 5‐28 Case 5‐29 Case 5‐30 Case 5‐31 Case 5‐32 Case 5‐33 Case 5‐34 Case 5‐35 Case 5‐36 Case 5‐37 Case 5‐38 Case 5‐39 Case 5‐40 Case 5‐41 Case 5‐42 Case 5‐43 Case 5‐44 Case 5‐45 Case 5‐46 Case 5‐47 Case 5‐48
X
Domain 2 Domain 3 Domain 4 Health Statistics, Biomedical Research, and Health Services Information Quality Organization Technology Management and Delivery and Systems X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X
Domain 5
Organization and Management
X
X
Domain 1
Health Data Management Case 5‐49 Case 5‐50 Case 5‐51 Case 5‐52 Case 5‐53 Case 5‐54 Case 5‐55 Case 5‐56 Section 6 Case 6‐1 Case 6‐2 Case 6‐3 Case 6‐4 Case 6‐5 Case 6‐6 Case 6‐7 Case 6‐8 Case 6‐9 Case 6‐10 Case 6‐11 Case 6‐12 Case 6‐13 Case 6‐14 Case 6‐15 Case 6‐16 Case 6‐17 Case 6‐18 Case 6‐19 Case 6‐20 Case 6‐21 Case 6‐22 Case 6‐23 Case 6‐24 Case 6‐25 Case 6‐26 Case 6‐27 Case 6‐28 Case 6‐29
X
Domain 2 Domain 3 Domain 4 Health Statistics, Biomedical Research, and Health Services Information Quality Organization Technology Management and Delivery and Systems X X X X X X X X
X X
X X
X
X X
X
X
X X
X X
X
X
X
Domain 5
Organization and Management
X X X X X X X X X X X X X X X X X X X X X X X X X X X X X
Domain 1
Health Data Management Section 7 Case 7‐1 Case 7‐2 Case 7‐3 Case 7‐4 Case 7‐5 Case 7‐6 Case 7‐7 Case 7‐8 Case 7‐9 Case 7‐10 Case 7‐11 Case 7‐12 Case 7‐13 Case 7‐14 Case 7‐15 Case 7‐16 Case 7‐17 Case 7‐18 Case 7‐19 Case 7‐20 Case 7‐21 Case 7‐22 Case 7‐23 Case 7‐24
Domain 2 Domain 3 Domain 4 Health Statistics, Biomedical Research, and Health Services Information Quality Organization Technology Management and Delivery and Systems X
X X X
X X X X X
X
X X X X X
X X X X
X X X
X X X X
X X X X X X X X X
X
X X
X X X X
X
X
X
X
X
Domain 5
Organization and Management X X X X X X X X X X X X X X X X X X X X X X X X
CASE STUDIES FOR HEALTH INFORMATION MANAGEMENT, 2ND EDITION CROSSWALK FOR ASSOCIATE DEGREE CURRICULUM COMPETENCIES DOMAINS Domain 1
Data Content, Structure, & Standards (Information Governance)
Domain 2 Domain 3 Domain 4 Domain 5 Domain 6
Information Protection: Access, Disclosure, Archival, Privacy & Security Informatics, Analytics and Data Use Revenue Management Compliance Leadership
Case Study 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1-9 1-10 1-11 1-12 1-13 1-14 1-15 1-16 1-17 1-18 1-19 1-20 1-21 1-22 1-23 1-24 1-25
Domain 1
Domain Domain 2 3 Section 1
Domain 4
Domain 5
X X X X X X X X X X X X X X X X X X X X X X X X
Domain 6
Case Study 2-1 2-2 2-3 2-4 2-5 2-6 2-7 2-8 2-9 2-10 2-11 2-12 2-13 2-14 2-15 2-16 2-17 2-18 2-19 2-20 2-21 2-22 2-23 2-24 2-25 2-26 2-27 2-28 2-29 2-30 2-31 2-32 2-33 2-34 2-35 2-36 2-37 2-38 2-39
Domain 1
Domain Domain 2 3 Section 2
Domain 4
Domain 5
X X X X X X X X X X X X X x x X X X X X X X X X X X X X X X X X X X X X X X X
Domain 6
Case Study 2-40 2-41 2-42 2-43 2-44 2-45 2-46 2-47 3-1 3-2 3-3 3-4 3-5 3-6 3-7 3-8 3-9 3-10 3-11 3-12 3-13 3-14 3-15 3-16 3-17 3-18 3-19 3-20 3-21 3-22 3-23 3-24 3-25 3-26 3-27 3-28 3-29 3-30
Domain 1
Domain 2
Domain 3
Domain 4 X
Domain 5
Domain 6
X X X X X X X Section 3 X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X
Case Study 3-31 3-32 3-33 4-1 4-2 4-3 4-4 4-5 4-6 4-7 4-8 4-9 4-10 4-11 4-12 4-13 4-14 4-15 4-16 4-17 4-18 4-19 4-20 4-21 4-22 4-23 4-24 4-25 4-26 4-27 4-28 4-29 4-30 4-31 4-32 4-33 4-34 4-35
Domain 1 X
Domain 2
Domain 3
Domain 4
Domain 5
Domain 6
X X Section 4 X X X X X X X X X X X X X X X X X X x X X X X X X X X X X X X X X X X
Case Study 4-35 4-36 4-37 4-38 4-39 5-1 5-2 5-3 5-4 5-5 5-6 5-7 5-8 5-9 5-10 5-11 5-12 5-13 5-14 5-15 5-16 5-17 5-18 5-19 5-20 5-21 5-22 5-23 5-24 5-25 5-26 5-27 5-28 5-29 5-30 5-31 5-32 5-33
Domain 1
Domain Domain 2 3 X X X X X Section 5 X x X X X X X X X X X X X X X X X X X X X X X X X x X X X x X
Domain 4
Domain 5
Domain 6
X X
Case Study 5-34 5-35 5-36 5-37 5-38 5-39 5-40 5-41 5-42 5-43 5-44 5-45 5-46 5-47 5-48 5-49 5-50 5-51 5-52 5-53 5-54 5-55 5-56
Domain 1
Domain 2
Domain 3 X X X X
Domain 4
Domain 5
Domain 6
X X X X X X X X X X X X X X X X X X X Section 6
6-1 6-2 6-3 6-4 6-5 6-6 6-7 6-8 6-9 6-10 6-11 6-12 6-13 6-14 6-15
X X X X X X X X X X X X X X X
Case Study 6-16 6-17 6-18 6-19 6-20 6-21 6-22 6-23 6-24 6-25 6-26 6-27 6-28 6-29
Domain 1
Domain 2
Domain 3
Domain 4
Domain 5
Domain 6 X X X X X X X X X X X X X X
Section 7 7-1 7-2 7-3 7-4 7-5 7-6 7-7 7-8 7-9 7-10 7-11 7-12 7-13 7-14 7-15 7-16 7-17 7-18 7-19 7-20 7-21 7-22 7-23 7-24
X X X X X X X X X X X X X X X X X X X X X X X X
CASE STUDIES FOR HEALTH INFORMATION MANAGEMENT, 2ND EDITION CROSSWALK FOR BACCALAUREATE DEGREE CURRICULUM COMPETENCIES DOMAINS Domain 1
Data Content, Structure, & Standards (Information Governance)
Domain 2 Domain 3 Domain 4 Domain 5 Domain 6
Information Protection: Access, Disclosure, Archival, Privacy & Security Informatics, Analytics and Data Use Revenue Management Compliance Leadership
Case Study 1-1 1-2 1-3 1-4 1-5 1-6 1-7 1-8 1-9 1-10 1-11 1-12 1-13 1-14 1-15 1-16 1-17 1-18 1-19 1-20 1-21 1-22 1-23 1-24 1-25
Domain 1
Domain Domain 2 3 Section 1
Domain 4
Domain 5
X X X X X X X X X X X X X X X X X X X X X X X X
Domain 6
Case Study 2-1 2-2 2-3 2-4 2-5 2-6 2-7 2-8 2-9 2-10 2-11 2-12 2-13 2-14 2-15 2-16 2-17 2-18 2-19 2-20 2-21 2-22 2-23 2-24 2-25 2-26 2-27 2-28 2-29 2-30 2-31 2-32 2-33 2-34 2-35 2-36 2-37 2-38 2-39
Domain 1
Domain Domain 2 3 Section 2
Domain 4
Domain 5
X X X X X X X X X X X X X x x X X X X X X X X X X X X X X X X X X X X X X X X
Domain 6
Case Study 2-40 2-41 2-42 2-43 2-44 2-45 2-46 2-47 3-1 3-2 3-3 3-4 3-5 3-6 3-7 3-8 3-9 3-10 3-11 3-12 3-13 3-14 3-15 3-16 3-17 3-18 3-19 3-20 3-21 3-22 3-23 3-24 3-25 3-26 3-27 3-28 3-29 3-30
Domain 1
Domain 2
Domain 3
Domain 4 X
Domain 5
Domain 6
X X X X X X X Section 3 X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X
Case Study 3-31 3-32 3-33 4-1 4-2 4-3 4-4 4-5 4-6 4-7 4-8 4-9 4-10 4-11 4-12 4-13 4-14 4-15 4-16 4-17 4-18 4-19 4-20 4-21 4-22 4-23 4-24 4-25 4-26 4-27 4-28 4-29 4-30 4-31 4-32 4-33 4-34 4-35
Domain 1 X
Domain 2
Domain 3
Domain 4
Domain 5
Domain 6
X X Section 4 X X X X X X X X X X X X X X X X X X x X X X X X X X X X X X X X X X X
Case Study 4-35 4-36 4-37 4-38 4-39 5-1 5-2 5-3 5-4 5-5 5-6 5-7 5-8 5-9 5-10 5-11 5-12 5-13 5-14 5-15 5-16 5-17 5-18 5-19 5-20 5-21 5-22 5-23 5-24 5-25 5-26 5-27 5-28 5-29 5-30 5-31 5-32 5-33
Domain 1
Domain Domain 2 3 X X X X X Section 5 X x X X X X X X X X X X X X X X X X X X X X X X X x X X X x X
Domain 4
Domain 5
Domain 6
X X
Case Study 5-34 5-35 5-36 5-37 5-38 5-39 5-40 5-41 5-42 5-43 5-44 5-45 5-46 5-47 5-48 5-49 5-50 5-51 5-52 5-53 5-54 5-55 5-56
Domain 1
Domain 2
Domain 3 X X X X
Domain 4
Domain 5
Domain 6
X X X X X X X X X X X X X X X X X X X Section 6
6-1 6-2 6-3 6-4 6-5 6-6 6-7 6-8 6-9 6-10 6-11 6-12 6-13 6-14 6-15
X X X X X X X X X X X X X X X
Case Study 6-16 6-17 6-18 6-19 6-20 6-21 6-22 6-23 6-24 6-25 6-26 6-27 6-28 6-29
Domain 1
Domain 2
Domain 3
Domain 4
Domain 5
Domain 6 X X X X X X X X X X X X X X
Section 7 7-1 7-2 7-3 7-4 7-5 7-6 7-7 7-8 7-9 7-10 7-11 7-12 7-13 7-14 7-15 7-16 7-17 7-18 7-19 7-20 7-21 7-22 7-23 7-24
X X X X X X X X X X X X X X X X X X X X X X X X