Creating a ‘Virtual’ HIM Department
COVER STORY
Creating a ‘Virtual’ HIM Department
Electronic Patient Records Are Becoming a Requirement for Integrated Delivery Systems
Special to ADVANCE
Imagine being able to simultaneously perform deficiency analysis and coding for several facilities across the region … without leaving your office. To answer the needs of integrated delivery systems (IDS), electronic patient record systems (EPRs) are creating “virtual” health information management (HIM) departments, enabling users to “transport” themselves to multiple sites with a click of a button.
IDSs are becoming a necessity in the competitive, increasingly managed health care industry. The current movement toward IDS has introduced a whole new level of complexity to the management of health information. In this emerging decentralized environment, the role of medical records management has expanded beyond the hospital facility to physician offices, reference laboratories, rehabilitation facilities, ambulatory care centers and other members of the IDS.
Realizing traditional paper-based methods’ inability to handle such a task, many of these multifacility enterprises are adopting EPRs to meet the growing challenges of patient record management.
Information Sharing Requirements
Mergers and acquisitions have for years been commonplace in most industries, yet it is a recent phenomenon in health care. Like their commercial-industry counterparts, by joining together, health care providers achieve economies of scale, streamline processes and ultimately improve the bottom line.
The IDS provides efficient, low-cost health care through the reduction of redundant services and duplicate capital cost expenditures. For instance, rather than several facilities purchasing the same expensive diagnostic imaging system, only one member of the IDS would need to purchase the system. While resource sharing is important to obtaining cost efficiencies, the success of IDS is dependent upon the efficient exchange of information between member entities. To accomplish this, IDS must find solutions—such as EPRs—to automate processes.
The IDS true team approach to health care delivery presents unique challenges for HIM professionals. For example, a report from a diagnostic imaging procedure must be accessible in real-time to physicians throughout the system. Also, any contacts of care throughout the IDS require the availability in near real-time of all encounter-related clinical information anywhere within the organization. This is necessary to effectively utilize resources and prevent instances such as physicians ordering redundant services because they are unaware of another physician’s actions.
To achieve true integration of formally disparate entities, many professionals have discovered the paper medical record is simply not up to the task of meeting imposed requirements. They have found it is difficult, if not impossible, to adequately share paper-based information in real-time.
CDRs and EPRs
To understand how EPRs address IDS needs, it is necessary to look at how they differ from another type of available system option, clinical data repositories (CDRs).
EPRs and CDRs are similar in many ways but tend to be fundamentally different in one important aspect. CDRs are collections of digital, clinical and encounter information about a patient, designed for physician use at or near the point of care. In general, CDRs do not achieve any medical record cost savings, but rely on savings from increased provider access to timely information and reduction of inappropriate or redundant services.
Rarely do CDRs address the paper component of the patient’s medical record or create records that meet legal and administrative requirements. EPRs, on the other hand, manage all digital patient information: the scanned paper record component and the processes related to record completion, accuracy and permanent storage.
Some IDSs are utilizing CDRs for information management only, leaving the medical record on paper for the time being. A growing number, however, have begun to develop specifications for EPR systems, believing the patient’s medical record (or business office folder) should be the first item to be managed electronically.
In addition to cost savings, utilizing EPRs allows IDSs to realize information-sharing objectives through elimination of paper records. The savings become very substantial when you factor in the cost efficiencies of sharing resources among multiple medical records departments.
Success in the managed care environment demands the availability of both clinical and financial patient information for intensive analysis. EPRs effectively manage patient business folders as easily as the medical record. This capability helps facilitate timely patient billing, a benefit that is extremely helpful when attempting to cost justify an EPR purchase. It also helps manage both clinical and financial information within one system, which assists in linking these types of information together for data analysis functions.
A Virtual Department
The latest designs for IDS-oriented EPRs create centralized access to all patient medical and business folder information from any enabled workstation throughout the organization. All documents associated with patient encounters are stored, on a historical basis, within the EPR. There also should be varying degrees of concurrent information available, depending upon how interfaces capture their data.
Documents (from digital interface and scanned paper origination) are available to any authorized organization user, from any site. For the most part, they are typically contained in medical and business records, plus other discrete data associated with patient demographics, codes, diagnosis, procedures, point-of-care or other systems that can feed the EPR with useful patient information.
This information may originate from any IDS entity such as a hospital, physician’s office, hospice, external laboratory or ambulatory surgery center, and is accessible across the whole organization. Having this information available in near real-time offers significant improvement in paper record access.
There are other exciting attributes to IDS electronic patient records. Centralized processing of the electronic record completion processes can literally create what have been called “virtual departments” or “departments without walls.” In this environment, HIM department activities can be performed for multiple sites from within one or more work areas located in different geographic locations. This kind of flexibility is invaluable as hospitals continue to merge and affiliate, creating larger and larger enterprises.
EPR Architectures
Integrated delivery system EPR architectures contain both centralized and decentralized components, activities and functions. For example, information systems may control a centralized set of servers within a data center to house system software, a central database of encounter information and possibly associated memory devices (such as hard disks, RAID arrays and optical jukeboxes) to store all the local (geographic area) member facility EPR documents. EPR system interfaces could be accomplished directly via the systems housed within the data center, since it is common practice to send clinical data to existing health information systems.
Examples of EPR-related activities that can be centralized within an IDS are:
- central system server(s) that coordinate all database, application, system administration and EPR Master Patient Index functions;
- interfaces to information captured into the hospital information system;
- management of networks utilized by EPR;
- mass storage (optical disk and RAID) of document images and database information from local facilities connected by high-speed (such as T1) links;
- synchronization of remote databases; and
- centralized workflow and application administration, such as deficiency analysis and encoding/abstracting.
Decentralized EPR components represent system functionalities managed by each IDS member facility. For example, each IDS member facility is responsible for security and administration of system policies and procedures for its site.
Each facility also will probably be responsible for paper scanning for each encounter. This is because, to date, there have been no viable schemes created to manage paper scanning off the physical site where it was created. Scanning at each site is inevitable due to the need for scanning paper records directly after discharge (or even concurrently, to some degree) to access system information before it is available within the EPR.
Examples of EPR-related activities that may be decentralized within an IDS are:
- mass storage of documents (if no high-speed links or locations outside local area are available);
- scanning;
- system administration for local site;
- database information that has been synchronized with the central site; and
- administration of local workflow and applications.
Creation of a virtual HIM department allows for the centralized management of many HIM processes and functions. Interface reconciliation, deficiency analysis, encoding, abstracting, release of information, among other processes, may all be managed from one location. Imagine being able to code all records for the system at one site, run deficiency analysis at another and reconcile interfaces at still another. These very real possibilities can greatly improve efficiency when EPRs are implemented within an IDS.
IDS emergence is a trend that will only continue to grow. To survive in today’s managed care environment, health care facilities will need to join forces to remove duplication of services and capital expenditures and lower the ever-skyrocketing cost of care. It is clear traditional record keeping will not suffice in such a complex, competitive environment. Comprehensive systems such as EPRs are needed to efficiently and cost-effectively manage information across the IDS.
* About the author: Kelly McLendon is the program manager for ChartMaxx Electronic Patient Record System at MedPlus Inc., Cincinnati, and a consultant to ADVANCE.
