|
|
December 26, 2006
Make HIM and IT one and the same? Sounds plausible, but until recently, no one had taken that leap. Visit Denver Health Medical Center, where the two departments became a single entity to improve patient care. The HIM and IT departments at Denver Health Medical Center always had a close, collaborative relationship, so the idea of merging the two—while unprecedented—wasn’t too far-fetched. “We needed to have a very close relationship just because of the nature of their medical record document imaging system that we had in place at the time, the coding requirements, and those types of things that are all data systems,” says Jeff Pelot, Denver Health’s chief technology officer. However, the close relationship didn’t help adoption rates when Denver Health, an integrated system that is Colorado’s largest “safety net” health institution, began implementing its inpatient computerized physician order entry (CPOE) system in 2004. “We did not have good adoption rates for CPOE. As a matter of fact, we were continually being told we were going to adversely affect patient care if we continued down the path we were going,” says Pelot. Enter Mary Beth Haugen, director of information services and HIM, whose role in the implementation project expanded from representing HIM to managing the clinical, Web, and financial applications to keep them in line with the business objectives. “They were struggling with the rollout and not getting a lot of acceptance because it was viewed as an IT project,” says Haugen. Denver Health Chief Information Officer (CIO) Gregg Veltri asked Haugen to oversee implementation of the CPOE to help bring the clinical and IT components together. “From an HIM perspective, although I’m not a clinician, I had a good understanding of what their data needs were, and I also knew how it needed to look in the legal medical record,” says Haugen. “That’s what kicked the whole thing off.” The “whole thing” was the decision to merge HIM and IT into one department, something that few—if any—other organizations had done successfully. Taking the Plunge But there was still a significant disconnect between IT and clinical applications, as evidenced by the slow CPOE adoption rate. Also, because IT focused primarily on the infrastructure, it viewed the legal medical record as mainly a repository for many feeds of data, and there was limited understanding of the electronic health record (EHR) concept. At the same time, HIM was struggling with the best way to champion the move toward an EHR. And just as there was a disconnect between IT and clinical applications, there was also a disconnect between HIM and IT. Thus, when the CIO floated the idea of merging the two departments, there was naturally some reluctance. However, no one could disagree with the objectives, which included creating efficiencies for both departments. Most importantly, though, IT needed a strong director who could act as an agent for change—a director with substantial influence with both the clinical and financial sides of the house to champion IT initiatives and influence the strategic direction for application implementation. Knowing the potential benefits, Haugen set aside her initial reservations and dove into researching the concept. “My peers in Denver were really supportive and thought we were heading in the right direction,” she recalls. “They weren’t ready to do it themselves, so it was more like ‘you go and do it and tell us how it turns out.’ But it was nice to have their support and agreement that this is the direction HIM should be going.” A literature search turned up several studies, including one from the AHIMA’s e-HIM task force which noted that the future of HIM is electronic, patient-centered, comprehensive, longitudinal, accessible, and credible. She also found a white paper by David J. Brailer, MD, PhD, former national coordinator for health information technology, which called for HIM to move closer to IT and become an agent for change in the healthcare information arena. What Haugen didn’t find were other hospitals that had undertaken a similar move, although there were several that were in the process of merging. But the research and support of her peers were enough to convince her that the merger would be highly beneficial to both departments and the organization as a whole. “We spent a lot of time talking about our issues and concerns, and we agreed as a group that while we didn’t know for sure if this was the right thing to do, it was worth the risk,” she says. “We also understood that once we merged, it wasn’t going to be easy to undo. We really were jumping off the cliff.” Reorganize and Restructure • data integrity manager: a combination of business process engineer, workflow and data analyst, enterprise application specialist, and consumer advocate responsible for release of information, HIM operations, identity management, data integrity, and smart card support and backup; • data integrity specialist: responsible for master patient index systems management and synchronization, verification of computer reports and statistics against paper record reports, and smart card creation and support; • EHR system manager: a combination of forms coordinator and clinical vocabulary manager responsible for enterprise document management, EHR clinical documentation and CPOE, chart completion and management, and transcription and handheld devices; and • information system (IS)/HIM compliance coordinator. In addition to decreasing staffing by five full-time employees, the merger also eliminated the night shift by providing the manager on call with information access and strategically accommodating internal and external customer needs. Denver Health also implemented processes designed to maximize the use of current technology for transfer of patient information. The newly merged department falls under the leadership of the CIO. Under the new structure, the HIM director is responsible for the clinical, financial, and billing applications support teams and the CPOE implementation and coding teams. A data integrity team and clinical support team were created, and all HIM functions were retained, including EHR, coding, those at the county jail, HIM operations, and compliance. Making a successful transition to a single IT/HIM department did require some significant role changes, particularly for the HIM team. “We did change quite a bit,” notes Haugen, who says her postmerger responsibilities are double what they were previously. “We looked at all of the projects we had coming down the pike and all the things we wanted to do as we moved toward the electronic health record. At the time, I had a clinical IS applications manager and a financial applications manager, and there was just no way they could do all of this and still move us toward the EHR. But I had some really strong managers in HIM who looked at changing their roles to make one management structure that met all the needs of HIM and all the IT applications.” Structurally, the changes facing the IT staff as a result of the merger were far less dramatic than those of HIM, but it has changed how they work with the organization, says Pelot. Prior to bringing the HIM, clinical, and financial managers under one roof with IT, “it was kind of fractured. I don’t think we had very good continuity between the two teams. It wasn’t horrible, but we didn’t have the kind of organization view that we do today as a result of the change,” he says. “On the infrastructure side, we haven’t changed much other than the way we deal with the hospital. What this merger has brought to us is a really clear understanding of how what we do impacts the organization. We’ve really enhanced what we do for our customers.” Impressive Outcomes “Some of the good is the opportunity it’s provided to the HIM staff. There are more career paths, they have more exposure to the IT side. We have more employees going back to school and into the HIM field,” Haugen says. “From a job perspective, one of the nice things for me is we’re more of a united, collaborative front and because of that, the projects we’re rolling out have been better.” Indeed, cross-fertilization of personnel between the two groups has created a synergy that allows the department to be more flexible and accommodating, which has resulted in improved technical support and an increased focus on enhancements for existing applications. The application strategy has also matured, and technology adoption rates have increased across all clinical areas. “The deal is we’ve been doing a lot of good things, but it was slow until we did the merger. Then we started really speeding up the adoption rate of technology to the point we can’t keep up with requests anymore,” says Pelot. “It’s had such a positive effect on the way the organization views technology at this point; our budgets now reflect that to a great extent as does the way we are treated within the organization. They see value in what we do as a result of the merger. That’s been a tremendous benefit from my perspective.” Adds Haugen: “They had spent several years before I came on board building the IT infrastructure and building that trust, so people had a respect for IT. But now there is more of an adoption because [we’ve gone beyond], ‘Here is the system and we can implement it.’ The IT staff didn’t really understand how the clinicians use the product and couldn’t really provide the enhancements to make it really work well. Now we have nursing staff that are IT members, we have pharmacy techs, we have people with clinical backgrounds who now work in IT, and that balance of clinicians and IT staff has been pretty powerful.” Perhaps the most impressive example of how the blended team can enhance existing systems and processes is the dramatic reduction in duplicate medical records—down from 10% to a miniscule 0.16%. That decline was a direct result of the collaboration between HIM and IT, and the leveraging of the unique skills and understanding each side brought to the table. IT first implemented a front-end system that enabled cleaner registrations and eliminated the creation of duplicate records. It then brought in data specialists to implement processes and created a duplicate enrollee report for monitoring purposes to ensure the now-clean data stayed clean. “You have to have processes all the way through from registration through the back end to make sure it stays clean,” says Haugen. “Without the relationship with IT, we would have gotten it down a little bit, but we would never have seen that kind of decrease and we could never have maintained it.” Jump-starting a Trend? Merging HIM and IT was also a popular subject at a recent College of Healthcare Information Management Executives conference, says Pelot. “Every CIO I talked to not only thought it was positive but thought it was something they should be doing. I would say it definitely is going to be a trend.” “I definitely feel it’s the direction more people will be moving in,” adds Haugen. — Elizabeth S. Roop is a Tampa, Fla.-based
freelance writer specializing in healthcare and HIT.
|
 |