Job Description Template for Medical Transcriptionist - PowerPoint by jac19503

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									Transitioning From Paper
to Electronic

   Diann Brown, MS, RHIA, CHP
   Director, Health Information Services
   Harris Methodist Fort Worth Hospital
   TXHIMA Fall Meeting
   September 14, 2007
Objectives

n   Describe difference between electronic
    document management system and
    electronic health record
n   Describe development of HIM strategic plan
n   Describe customer-centric
n   Review process changes




                  Diann Brown, MS, RHIA, CHP     2
Definitions

n   Electronic document management system
    q   Paper document scanned into a document
        imaging system that has workflow

n   Electronic health record
    q   Medical record created electronically or digitally




                        Diann Brown, MS, RHIA, CHP           3
    What is Document Imaging?

n   Typically captures information stored on
    paper documents
n   Provides simultaneous access to information
n   Records are indexed and organized
n   Stored on optical disks for permanent
    archival storage




                  Diann Brown, MS, RHIA, CHP      4
Project Risks
                Understanding and
                Mitigating Project Risks
HIM Strategic Goals

n   Support current and future hospital strategic
    initiatives
n   Fully utilize document imaging system
n   Easy and improved access to information by
    care providers
n   Implement electronic signatures
n   Decrease AR days held in coding
n   Decrease delinquency of medical records
n   Home-based coding program

                   Diann Brown, MS, RHIA, CHP       6
Readiness Assessment

n   Review current interfaces
n   Review HIM department workflows
n   HR requirements for telecommuting
n   Determine IS resources needed
n   Vendors willingness to partner




                  Diann Brown, MS, RHIA, CHP   7
Establish Project Plan

n   Budget review and approval
n   Secure executive support and approval
n   Communicate initiative to stakeholders
n   Secure IS resources
n   Select project team members




                  Diann Brown, MS, RHIA, CHP   8
Project Planning

n   Establish test group
    q   HIM employees
    q   Customers (physicians, clinical staff,
        administrative staff, etc)
n   Analyze new workflow requirements
n   Flow chart changes to old workflow
n   Develop transition and training plan
n   Develop communication plan

                       Diann Brown, MS, RHIA, CHP   9
Human Resources
Component
n   Assess employee skills
n   Develop baseline for new productivity
    standards
n   Develop quality standards
n   Revise job description
n   Review employee performance evaluations
n   Determine # FTEs required
n   Develop guidelines for home-based

                 Diann Brown, MS, RHIA, CHP   10
P & P Development

n   Review telecommuting policy
n   Develop new processes
    q   Prepping
    q   Scanning
    q   Quality audits
    q   Analysis
    q   Record completion
    q   Coding
n   Assign responsibility for working queues
n   SOP for help desk

                        Diann Brown, MS, RHIA, CHP   11
New Workflows might
be difficult at first




        Diann Brown, MS, RHIA, CHP   12
                  Customers Affected

n   HIM department                n   Risk Management
n   Physicians                    n   Administrative Staff
n   Clinical staff                n   Auditors
n   Case Management               n   Insurance Reviewers
n   Quality Management
n   Patients




                   Diann Brown, MS, RHIA, CHP                13
Customer-centric Approach

    n   Defined customer groups
        q   Identified needs
        q   Determined impact of change
        q   Determined access needed
    n   Established training process (who, when,
        approach)
    n   Developed transition plan to complete
        paper-records
    n   Developed communication plan


                  Diann Brown, MS, RHIA, CHP       14
Customer-centric Support

    n   Current processes
    n   New processes
    n   Equipment needed
    n   Training/support required
    n   Support from key stakeholders
        q   Ex: Medical Board endorsement
    n   Communication plan


                 Diann Brown, MS, RHIA, CHP   15
Customer-centric Forms
Management
     n   Policy
     n   Forms committee with authority to act
     n   Committee membership
     n   Develop form template for standardization
         q   Barcode
         q   Patient ID
         q   Margins
         q   Shading
         q   Size
         q   Abbreviations

                   Diann Brown, MS, RHIA, CHP    16
 HARRIS METHODIST FORT WORTH HOSPITAL
 Health Information Services
                                           Patient    dischaqged
 Medical Record Flow Chart – All Records



                                             Recoqds qetqieved
                                                fqom units.




                             YE              NO
                                              Visit appqopqiate
  Pqep chaqts                S Aqe all qecoqds
            Batch contqol pages
                                  qeceived?     clinical aqea
  foq scanning(ECPs) pqinted.               to qetqieve chaqt.



                                                                              YE
                           Index images in                                    S
                                                                  Quality images?        On-line
     Scan chaqts                                       QA                                analysis
                           manual indexing


                                                                        NO
   Coding cases                                                               Physician completes
     tqiggeqed                                                              on-line, electqonically
                                                                   Rescan bad
                                                                       No
                                                                                 sign oq dictate
                                                                images / documents


                                                                             Reanalyze, text editing,
  Accounts coded
                                                                              addendums, annotation,
       in CDA
                                                                                and missing documents



                                                                                    NO
Codes inteqface to                                                                Recoqd complete?
   billing system

                                                                                         YE
                                                                                         S
        Complete                                                                         Complete
                                           Diann Brown, MS, RHIA, CHP                               17
Physician Completion Transition
Plan
  Stakeholder   Current Process        New Process                Training                Communication
                                                                  Support                     Plan

Physician       Dictate via           No change           None                          None
                Dictaphone

                Sign reports on       No change           None                          None
                open charts


                Complete              Complete on-line    Develop training toolkit to   Assistance from
                discharge record      from any location   include: CareGate info;       Physician
                records in lounge                         instructions for              Champions; PR;
                                                          AccessANYware,                Medical Affairs, HIM,
                                                          CompletionANYware             Physician Support
                                                          PSS                           Services


                Signatures            Electronic
                                      signature

                Answer coding         Electronic
                queries               queries




                                    Diann Brown, MS, RHIA, CHP                                          18
Physician Benefits

n   Remotely complete and electronically sign
    incomplete records
    q   Access thru physician portal
n   Improved access and workflow
n   Simultaneous access to discharged records
    for all clinicians
n   Records available on-line after discharge for
    follow-up care
n   More time for patient care

                       Diann Brown, MS, RHIA, CHP   19
How Physicians
Access Records
n   On Campus Direct Access
    q   Provide dedicated computers
        n   Physician lounges
        n   ED department
        n   Clinical workstations on units
n   Off Campus
        n   Office
        n   Home




                           Diann Brown, MS, RHIA, CHP   20
Physician Process Changes

             TODAY                                     FUTURE
n   Dictate reports via                      q   No change
    Dictaphone
                                             q   No change - HIS staff
                                                 scans reports
n   Sign reports on unit

                                             q   No charts delivered
n   Complete records after
                                             q   No calling & waiting
    discharge in HIS
                                             q   Complete records from
    q Manual signatures                          any location
    q Dictation                                  n      Electronic signatures
    q   Coding queries                           n      Use Dictaphone
                                                 n      Electronic on-line
                           Diann Brown, MS, RHIA, CHP                           21
Example:
Process Changes in HIS
         Paper Record                                    Electronic Record

   q   Reconciliation process                      q   Reconciliation process
   q   Assembly                                    q   Prepping
   q   Analysis                                    q   Scanning
   q   Chart retrieval                             q   Indexing
   q   Filing loose reports                        q   Quality check (QA)
   q   Re-filing retrieved charts                  q   Analysis
   q   Code from paper chart                       q   Interface/scan reports
                                                   q   Manage work queue
                                                   q   Coding online


                      Diann Brown, MS, RHIA, CHP                           22
Coding Transition Plan
   Stakeholder    Current Process          New Process                Training         Communication
                                                                      Support              Plan


Coding           Hybrid – paper         Imaged record using      Update              Manager meet with
                 chart and imaged       CodingANYware            procedures; train   staff; review roll out
                 record                                          staff on software   plan for moving all
                                                                                     coders to imaged
                                                                                     record

                                        Expand home-based
                                        coding availability



                 Manual coding          On-line coding           Process
                 query process          queries                  developed &
                                                                 tested

                 Wait for transcribed   Reports available        Review/update
                 or late loose          on-line thru interface   current procedure
                 reports                or scanned image




                                  Diann Brown, MS, RHIA, CHP                                            23
Analysis & Completion
Transition Plan
   Stakeholder       Current Process          New Process             Training           Communication
                                                                      Support                Plan


Record Processing   Reconcile receipt      No change
                    of records & fetal
                    strips



                    Print & place labels   Eliminate process
                    on folders; folder
                    records


                    Analyze paper          Analyze records on-
                    charts                 line


                    Enter deficiencies     Assign deficiencies   Train staff; update   meet with staff to
                    in ChartFact           in                    current procedure     train & communicate
                                           CompletionANYware                           changes




                                     Diann Brown, MS, RHIA, CHP                                        24
Analysis & Completion
Transition Plan
 Stakeholder   Current Process         New Process               Training/         Communication Plan
                                                                 Support


Physician      Pull records for     Assist physicians     Update current
Completion     completion           with completing       procedures
                                    records on-line

               File transcribed     Eliminate process;    Train staff on
               reports              reports interfaced    CompletionANYware


               Reanalyze records    On-line reanalysis;   Train staff to
               for completion;      eliminate ChartFact   reanalyze records
               Update ChartFact                           using
                                                          CompletionANYware
               Notify physicians    Use                   Train staff on reports
               incomplete/          CompletionANYware     in
               delinquent records                         CompletionANYware




                                    Diann Brown, MS, RHIA, CHP                                  25
Document Imaging Transition
Plan
 Stakeholder    Current Process            New Process               Training/
                                                                     Support
                                                                                       Communication Plan



Document        Prep, scan, index,      Expand to include      Reassign some
Imaging         QA ED and               OPS, OBS,              staff to this area;
                outpatient              Inpatient records      add additional staff
                Diagnostic records
                Analysis ED             Transition to record   Train staff
                records                 physician
                                        completion staff

Chart Request   Retrieve records        Transition users to    Train users to use     update record access
Desk            for review or audits    on-line audits &       system; grant          policy /procedure; update
                                        review – eliminate     security to users      chart request procedure
                                        FTE
                                        Move function to       Train ROI staff
                                        ROI




                                       Diann Brown, MS, RHIA, CHP                                        26
Document Imaging Transition
Plan
  Stakeholder      Current Process          New Process             Training/
                                                                    Support
                                                                                      Communication Plan



Loose File Clerk   Research and          Sort reports with &   Train HIM specialist
                   write MRN/DC          without acct
                   date & service on     numbers
                   reports
                   Sort loose reports    Research reports
                                         w/out acct #


                   File Reports          Route reports with
                                         acct # to scan


                                         Eliminate 1 FTE –
                                         move function to
                                         reconciliation desk




                                        Diann Brown, MS, RHIA, CHP                                  27
ROI & Transcription
Transition Plan
  Stakeholder    Current Process         New Process               Training/
                                                                   Support
                                                                                  Communication Plan



Release of      Retrieve hard copy    Same process            Manager review     Update policy; update
Information     charts & imaged                               information with   record storage history
                charts to respond                             staff
                to requestors
                                      Printing imaged
                                      records


Transcription   Prioritize reports    Prioritize reports as   None, process in
Specialist      for uncoded           needed in               place
                records               Dictaphone

                Update                Eliminate process       Update policy      Manager meet with
                deficiencies in                                                  affected staff &
                ChartFact                                                        implement changes




                                     Diann Brown, MS, RHIA, CHP                                      28
Transcription Transition Plan
   Stakeholder       Current Process           New Process          Training/   Communication Plan
                                                                    Support


Transcription      Verify fax #s in         No change
Specialist         Rightfax; verify
                   reports faxed and
                   resend
                   Manually tag             Eliminate process
                   deficiency on report;
                   file reports

                   ID and correct           No change
                   reports


Transcriptionist   Transcribe dictated      No change
                   reports




                                       Diann Brown, MS, RHIA, CHP                             29
Overall Customer
Benefits Achieved
   n   Medical record images available online immediately
       after scanning
   n   Simultaneous access to medical record
   n   Physician remote access and completion of records
   n   Electronic signatures
   n   Increased physician and hospital staff satisfaction
   n   Decreased delinquency rate
   n   Increased efficiency with release of information
   n   Ability to code & abstract remotely (home-based
       coding)
   n   Decreased AR days




                      Diann Brown, MS, RHIA, CHP             30
Customers Testimony
    ―The ability to access the record for my job greatly
       affects efficiency in the quality, safety and
       satisfactions aspects of the manager’s job—I no
       longer have to request a record—I can just pull it up
       on my desktop—this is the first thing to come along in
       years that actually makes it easier to do my job!‖


      Denise Doneghy, RN, Manager, Med/Surg ICU




                 Diann Brown, MS, RHIA, CHP                 31
Customers Testimony

    ―Dr. Dan Morton, Gastroenterologist,
      states, ―I love it. It has dramatically
      made record completion easier as
      well as allowing me to access
      clinically relevant data from previous
      admissions in the hospital, at the
      office and at home."



              Diann Brown, MS, RHIA, CHP        32
Questions?



            Contact Info

       diannbrown@texashealth.org




             Diann Brown, MS, RHIA, CHP   33

								
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