Lois Givens and Rich Marreel are working constructively
toward implementation of a successful electronic health
record (EHR) at BryanLGH Medical Center in Lincoln,
Nebraska. These directors of Health Information Management
and Information Technology have combined forces to create
a unified vision of the EHR and to constructively manage
the change associated with implementation. What are
they doing to assure a successful implementation? See,
"Creating a Unified Vision of the EHR." to
find out.
Many hospitals find it difficult to comply with
HIPAA's Accounting of Disclosures requirement. For example,
how does a hospital capture and record in each patient
accounting, the mandatory disclosures of PHI it made
electronically to the state?
Our colleagues and clients have told us about two methods
they're using to comply with this challenging standard:
Some are working with a software vendor to create
interfaces between their software programs that
disclose PHI electronically and their accounting
of disclosure software
Others have merely added to the bottom of their
accounting of disclosure printout a list of routine
disclosures the hospital makes for public purposes.
How is your organization tracking such disclosures?
We'd love to hear your solution. You may contact us
at info@care-communications.com.
Document imaging is an important component of the
electronic health record that can improve the availability
of patient information and contribute to enhanced productivity
and a higher quality of care. But how does an organization
justify the cost?
Judy Ferraro, RHIA, HIM Director at Elmhurst Memorial
Hospital advises, "Include other departments in developing
an imaging system proposal. I worked, for example, with
the directors of patient accounts and information services.
We've had the imaging system for about five years now,
and it's been very successful. Although the imaging
system has not reduced FTE's in IS or HIM, it has enhanced
productivity in many areas, most notably in patient
accounts."
Tumor registrars should expect another big change
January 1, 2004. The Commission on Cancer has announced
a new coding system for staging cancer. This new system
is called Collaborative Staging.
Cancer staging is currently performed using three different
staging systems with different purposes and sets of
rules. Some of the rules are conflicting in the three
systems and thus affect the quality of data. In addition,
duplication of effort occurs when multiple data sets
are collected. Collaborative Staging is designed to
provide a common data set to meet the needs of all three
staging systems, and provide a comprehensive system
to improve data quality.
For more information and instructions, go to www.seer.cancer.gov and search for "collaborative
staging".
"Duplicate health record numbers increase a health
care provider's risk of a serious medical error says
Patty Thierry, Care Communication's Vice President of
Operations and CIO.
A health care provider's master patient index (MPI)
contains patient names and respective health record
numbers. If a patient has more than one number, the
patient may have more than one record. If the situation
is not apparent to the physician, he or she may access
only one of the patient's health records. Important
information contained in the other record may be overlooked,
placing the patient, physician and facility at serious
risk.
Similar problems occur when more than one patient share
the same health record number. A physician may access
a record and make a decision based on an entry that
actually belongs to another patient.
In order to minimize risk, it's important that organizations
address the problem of MPI errors sooner rather than
later. "The longer health providers wait, the more errors
are created and the more expensive the problem is to
correct," says Thierry.
Most health care providers find it helpful to contract
with organizations that specialize in MPI clean up.
Such organizations use complex algorithms that identify
MPI errors home grown programs miss.
These organizations also provide or partner with firms
who provide temporary staffing services. Temporary staffing
is crucial because the number of MPI errors is usually
significant and beyond the health care provider's ability
to absorb.
Firms offering MPI clean up services also provide project
management services. Project managers work with the
health care provider's health information management
(HIM) director to arrange for work space and computer
access, develop policies and procedures, train and supervise
staff, perform quality control and payroll related activities.
Most health care providers find that it's not practical
to expect HIM directors to work afternoons, evenings
and weekends to manage the MPI clean up on top of their
regular duties.
Correcting errors in a master patient index is an enormous
project. Correcting existing errors is but one piece.
The second is developing a program aimed at eliminating
or reducing future errors. We'll talk about that in
our next issue of The CARE Dialog.
