How one hospital erased the HIM paper trail

Medical center reduces delinquency rate by 71%

When Hansel and Grethel were lost in the forest, they dropped bread crumbs along the way hoping the trail would show them the path home.

Similarly, Jean Terry, MBA, RRA, manager of health information services at Satilla Regional Medical Center in Waycross, GA, is forging a path toward improved health information management (HIM), an ongoing journey that started nine years ago. But unlike the fictional bread crumbs, the paper trail for the medical records department is being overtaken by a streamlined electronic medium.

And the efforts started nine years ago appear to be paying off. Since beginning the new HIM procedures, Satilla Regional's medical record files delinquency rate over 30 days has decreased 71% from September 1997 to February 1998.

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Following a consultant's visit to the hospital last year that culminated in an evaluation suggesting changes, Terry conferred with the medical director. "I asked in a `Lend me your ear' way, and that meeting was the catalyst for the new methods we use today," says Terry. After working closely with the medical director, the medical records department staff, and the physicians, change began to take place, she adds.

To establish these procedures, Terry first talked with neighboring hospitals that were using a similar system to integrate their knowledge with what she already had learned. Then, she garnered support for her ideas with physicians and staff who had worked with this type of system at hospitals throughout the country.

Pending cases cut nearly in half

Once she had support for her proposal, she talked with the medical staff committee members, and a plan was drafted for the HIM change. This plan was made nine months prior to the next scheduled Joint Commission on Accreditation of Healthcare Organizations visit and was implemented six months prior to the visit. The hospital's preliminary score from the Joint Commission's visit in March of this year is 99%.

The Joint Commission requires that a medical record file be completed within a 30-day period. Before the new system was started, 1,100 deficiencies would be pending at any given time. With the updated system, 600 deficiencies are pending at any given time. Terry attributes much of the success in streamlining the medical records system to SoftMed Systems in Bethesda, MD, maker of the software the hospital uses for medical records.

A date was scheduled for the changeover, and very little altered from the original plan. Several changes were made. For example, a centralized location for incomplete files was established. A few physicians were hesitant to surrender the old system where files were placed in their boxes for signature. Under the old system, once the physician completed the file, it was routed to the next person, creating a long and timely paper trail. Now, the physicians pull their own files from the central locale where they are filed in terminal digit order. Doctors know which files to sign because there is a printout of their incomplete files each day.

Included in the new procedures was the use of bar codes, first introduced to the facility in 1990, to identify medical records, allowing staff to charge out a stack of records very quickly. Using a light pen, the bar code can be readily scanned. Prior to use of these codes, cases had to be keyed in by a staff person leaving room for data entry error. With the bar code system, errors are minimized.

Staffing levels adjusted to establish system

Also to establish the system, the medical records department was staffed on evenings and weekends. Additional employees were needed for the extended hours. Terry hired 1.5 full-time equivalent (FTE) staff to work the added hours. The hospital employs 22 medical records department staff, and the FTEs perform other functions, as well, she notes.

Some of the benefits realized from instituting the new procedures include:

· improved accessibility of medical records files;

· current information available on incomplete files;

· medical record completions occur faster, allowing faster billing and payment to the hospital.

Feedback about the new medical records procedures has been positive. The medical records staff and physicians are pleased with the new system. Even those hesitant to initiate the procedures have realized the reduction in workload and paper trails. Terry says her staff morale has increased due to the new procedures. She and her assistant worked closely with her departmental staff to get their input on the changes and their response as the system was implemented.

Looking to the future, the hospital has a goal to obtain electronic signature for medical records by September 1998. Terry said she would change very little about the implementation of the new system.

Through her prior attempts to spearhead this innovative program, she gained a wealth of knowledge which served her well when the change took place. Key to the effectiveness of the transition, Terry says, was a " base of trust" developed between her, the staff, and the physicians. The results speak for themselves, and although Terry's journey into HIM improvement is not over, the paper trail is shorter due to these new procedures.

· Jean Terry, MBA, RRA, Manager, Health Information Services, Satilla Regional Medical Center, 410 Darling Ave., Waycross, GA 3l501. Telephone: (912) 283-3030. Fax: (912) 287-2648.

· SoftMed Systems, 6610 Rockledge Drive, Suite 500, Bethesda, MD 20817. Telephone: (301) 897-3400.