Vol. 18 •Issue 9 • Page 16
Going Electronic A Customer-Centric Approach
See how this HIM department led its hospital from paper to electronic records by thinking of everyone else’s needs before its own.
A hospital deciding to go electronic is as disruptive a move any facility can make—which is why it’s almost always decided on, organized and planned from the top down, by the hospital’s CEO, chief information officer and/or chief financial officer.
The fact that this story starts from the bottom up is exactly what makes the move to electronic records at Harris Methodist Fort Worth (HMFW) Hospital in Forth Worth, TX, so unique.
An Unlikely Start
Five years ago, the idea to move the entire 710-bed hospital to a document imaging system didn’t start at a
roundtable meeting of C-level executives, but at a more unexpected place: the HIM department, at its strategic planning meeting.
Diann Brown, MS, RHIA, CHP, director of health information services, had a vision: to make her HIM department the best customer service department it could be. That is, after all, essentially what an HIM department is. It has customers—physicians, nurses, the centralized business office and other clinical and administrative staff—who all need something from the HIM department, and who all came to Brown with a common complaint: they wanted instant access to charts, without having to wait for HIM.
At the time, most records were on paper; the past 18 months were onsite, the rest were off-site, and the only records scanned into their electronic document management system (EDMS) were from the emergency department.
Brown knew she wanted to get records online and available to everyone, but with 710 beds, more than 1,000 physicians and 13 hospitals in the Texas Health Resources system, she needed a quick fix that also fit in with the system’s vision of going live on an EHR in 3 years. Brown’s solution was to get every department in the hospital up and running on the EDMS, which was not only a great alternative, but also became an ideal transition to the EHR.
EDMS vs. EHR
What’s the difference between an EDMS and EHR, you might be wondering? According to Brown, the distinction is important. In an EDMS, the physicians still handwrite notes or dictate patient encounters. The paper notes are then scanned or transcribed into the EDMS and essentially “turn” electronic, giving hospital staff instant access to the charts because they’re now online. Subsequently, when a physician pulls up a chart on the computer, even though the chart looks like handwriting on the screen, the physician is able to type in anything missing or make edits, and then sign off with electronic signature. The chart starts on paper but finishes on the computer.
An EHR, on the other hand, doesn’t allow for paper at all. Instead, the physician does all of the documentation from start to finish directly into the computer. This can be very disruptive to the physician’s normal workflow considering he or she is now interacting with the patient and a computer. At HMFW, they weren’t quite ready to take that step.
“The EDMS is a great stepping stone because you can implement it in a year or less; with an EHR, you’ve got to change the entire organization’s workflow before you can get there,” Brown explained. “An EDMS allows doctors to get used to using computers and completing records online, but is a lot less expensive than a true EHR.”
To the Board
Brown then made a bold move: she made the goal of getting the entire hospital’s records on an EDMS part of the HIM department’s strategic plan—a huge undertaking for any HIM department.
To get the medical board’s approval, Brown presented the EDMS, not with workflow improvement as the No. 1 priority, but with customer-service on top. She aimed to show how the EDMS could help HIM help everyone else. “I approached it that HIM is a service department, there to facilitate access to clinical information so our patients can receive the best care possible—that the EDMS could make it easier for them,” she said.
Brown backed this up with facts. She showed that 80 percent of deficiencies assigned after discharge were because of signatures—and that electronic signature could improve this for the physicians tremendously.
“That was a big selling point to the medical staff—that they didn’t have to wait any longer for someone to retrieve the paper charts for them; they didn’t have to make a special trip here to the office,” she said. “That’s when the rest of the leadership team became aware of all we could provide to assist in the care of patients.”
A Unique Approach
In taking a customer-centric approach to an EDMS, the HIM department’s strategic plan was unique. For one, Brown scheduled computer stations to be built in all four physician lounges, so physicians could complete their records during their downtime—an expense Brown absorbed in the HIM department’s budget.
This further illustrated Brown’s view of the EDMS as a tool for HIM to improve its service to its customers—physicians and nurses alike. “We wanted to make it as easy for them as possible to gain access to the charts,” she said.
Brown also made sure the customers were involved in the system’s design. She put together a group of physician champions who went through the testing with the HIM department; they gave feedback and helped make changes. “By the time we were ready to go live, the physician piece was very smooth because we had the physicians involved,” Brown said. “We wanted to impact them the least amount of time possible; it needed to be efficient for them.”
So, how would the EDMS implementation have been different if Brown focused on workflow, rather than her customers? For one, Brown said she probably would have left the focus solely to getting remote coding to improve efficiencies in the HIM department, and would have left the rest of the hospital out of the equation entirely.
“I could have certainly streamlined the processes here in my department but that doesn’t necessarily mean that would have been good for the customer,” she said. “Here I showed them I could solve two business problems at the same time: 1) access to patient charts for the customer and 2) efficiencies in the HIM department.”
Another result, Brown said, was an overwhelming amount of excitement and enthusiasm throughout the hospital staff about going electronic—not the backlash or resistance some hospitals report.
“Because they were part of the process, they really understood we were there to help them solve their business problems, to make it easier for them,” Brown added. “Change is very difficult, but because of the way we did it, we got people to embrace it and accept it a lot faster. If I was only focused on improving HIM workflow, I certainly would not have gotten the cooperation we did.”
The hospital is currently looking forward to going live on an EHR in September and, according to Brown, it was well worth the wait. “Since our physicians have been using our EDMS for almost 3 years now, we’re just so far ahead of the game,” she said. “It’s created a lot of excitement.”
What Brown said she is most proud of in leading the EDMS implementation, is the way the hospital staff now views the HIM department. “Their perception of HIM has changed,” she said. “It certainly has raised the expectations of the HIM department, and people know that we play a very important role in the care of our patients.
“I’ve had several [physicians] tell me that one of the best things we did for them was provide them the tools so they can be more effective with their jobs,” Brown added. “The bottom line is, if I came into HMFW as a patient in the emergency department, I would want those caregivers to have all the available information so they can take the best care of me—so why wouldn’t we do that for all of our patients? It’s the right thing to do.”
Ainsley Maloney is an assistant editor with ADVANCE.
Efficiencies in HIM
Workflow efficiencies may not have been the No. 1 goal of the electronic document management system (EDMS) at Harris Methodist Fort Worth (HMFW) Hospital in Texas, but it was certainly a byproduct—especially to the HIM department.
Charts are now available to physicians and hospital staff less than 24 hours after discharge, as compared to the 2 or more days it used to take, said Diann Brown, MS, RHIA, CHP, director of health information services. With e-signature, physicians no longer have to walk down to the HIM department and wait in line, and the delinquency rate in HIM had decreased from 25 percent to 9 percent.
Also, because physicians are able to edit deficiencies directly online, it allows for quicker chart turnaround. “[Before] when documentation was missing from the paper record, the claim had to be held until it was added to the record,” said Latoshe Davis, CCS, a coder at HMFW. “Now when the documentation is added, the record comes up in the queue to be coded. The reduction in time is significant.”
As part of the strategic plan, Brown worked with their document imaging and coding vendors to put both systems on one screen, so the coders no longer had to toggle back and forth. Coding productivity has since increased 10 percent, and despite the hospital adding 100 beds in recent year, Brown didn’t have to hire a single extra full time equivalent (FTE) to keep up.
She also was able to start a home-based coding program, which has increased employee satisfaction and brought the coder retention rate to 95 percent. “Working from home has been great,” said Margaret Moon, RHIT, a coder at HMFW. “I can set my own schedule, and I am much more efficient.”
Efficiencies in HIM department workflow also mean greater revenue for the hospital. The accounts receivable (A/R) days held in coding has decreased. With e-signature, records are available faster for coding and the hospital is able to bill faster, Brown said. “Many insurance carriers’ billing deadlines have been lowered to 30 or 45 days after discharge,” Brown explained. “If you don’t have the account billed and out the door, you run the risk of not being able to recoup the dollars you should. We don’t have that issue here.”