On April 22 2014, I scheduled an onsite interview with *********, the HIS Director of St. Francis Medical Center. This facility is located **************************. The facility was established in **** by a non-profit organization. St. Francis is the largest and busiest private trauma center in ************, treating ***** children and adults each year Recent honors and awards for this facility include 2013 Healthcare Leadership Award Hospital Finalist – ***************l
Top 50 U.S. Cardiovascular Hospitals 2012 – Thompson Reuters, 2012 High Performing Hospital in ENT and Urology – U.S. News and World Report, and 2011 Honorable mention Award for top performance in Evidence-Based Care, Mortality, and Cost of Care – Premier QUEST (St. Francis Medical Center, 2014). Operations and Structure
Department Organization Within the HIS department, there are a total of 39 employees. 35 of these are fulltime employees and the remaining four are temporary and part-time workers. Nola Davis who is the director of the department, holds the RHIA credential. There are also 3 RHIT and 6 CCS credentialed staff members. The distribution of employees is very dynamic. Certain tasks are solely designated for certain workers, but the majority of the operations are distributed among 80% of the staff.
Nola informed me that it’s very important for the HIS department to have cross-trained staff that can switch roles as department needs develop. The titles held by the HIS staff are Record Technicians, Clerks, and Coders. Record Technicians are mainly responsible for facilitating release of record requests and chart deficiency analysis. The clerks’ main role is chart prepping (aka chart assembly (Sayles, 2013, p. 350)), chart filing, scanning of patient signed documents, and paper record retrieval for emergency room visits and discharges from acute care. The coders are responsible for interpreting emergency room records, in-patient hospitalizations, and consultation records and assigning the correct ICD 9 CM and CPT codes to all encounters. Software applications
The master patient index and electronic health record system runs on software developed by McKesson Corporation. The system is called HBO & Company (HBOC), St. Francis has used this system for 15 – 20 years. Within HBOC, the preferred method of filing system is terminal digit. As a facility, St Francis’ chart structure is roughly 80% electronic. There are still some documents that are paper-based including emergency room records, and documents signed by patients.
The older records that were generated prior to EHR implementation are tabbed with dividers and color coded. The paper filing format was developed with input from the nursing staff to insure cohesiveness. The electronic health record format was designed to match the paper filing system. Charts are tracked within the organization with 3M. Any non-electronically generated document is scanned with a barcode system to insure all records are accounted for and available for retrieval upon request. St. Francis Health Record
St. Francis’ definition of the legal health record is the documentation of patient health information that is generated within their organization regardless of storage and generated type of media. The facilities bylaws and policies mirror standards established by the AHIMA HER practice council which state, “The determining factor in whether a document is considered part of the legal health record is not where the information resides or its format, but rather how the information is used and whether it is reasonable to expect the information to be reasonably released when a request for a complete health record is received (AHIMA, 2007).”
The facility has an 80% to 20% ratio of electronic to paper-based record respectively. The EHR encompasses nearly all encounters within the facility. The patient copied and signed documents like consent forms and copies of drivers’ licenses are initially paper format but are eventually scanned into the EHR system to become part of the patients’ health record.
The emergency department and anesthesiology are the last departments still using hybrid and paper based record systems. Nola stated that the vision of the facility is to be 100% electronic by the end of calendar year 2014 including kiosks that patients can use to electronically sign documents. Record Retention
Records that were created before the introduction of an electronic medical record system are stored off-site by a vendor for an undisclosed amount. These older pre-EHR records were not scanned into the EHR system but retained for a minimum of 21 years for legal requests. All newly generated paper records are kept within the department for the entire calendar year and purged during the first month of the year. HIPPA and Security
HIPPA rules are an integral part to the operations of St. Francis Medical Center. Privacy rules and regulations are enforced by a designated compliance officer who is also the organizations’ Vice President. ******** informed me that ***** did handle the compliance and HIPPA rule enforcement at one time, but the daily task combined with managing the HIS department became very demanding and the duty was handed over to someone who could devote all their resources to the task. Members of the HIS and other departments are required to successfully complete annual compliance training modules on an annual basis.
References AHIMA. (2007). Fundamentals of the Legal Health Record and Designated Record Set. Retrieved from AHIMA Body of Knowledge: http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_048604.hcsp?dDocName=bok1_048604 Sayles, N. (2013). Health Information Management: An Applied Approach. AHIMA Press.