SCENARIO: You have just been hired as the HIM Quality Coordinator. This is a new position in the HIM Department. Your job tasks read as follows:

• Develop and implement the HIM Department Quality Plan
• Develop data collection, date analysis, and data presentation tools for use in the quality plan.
• Report findings to the HIM Director, Administration, Medical Staff Director, and Medical Staff Committees as appropriate.
• Other duties as assigned.

The facility is a 338-bed hospital with active ER and outpatient services. There are 45 employees in the HIM Department. About 75% of the medical record is electronic. Those documents are not printed out. The remaining 25% of the record is paper and is scanned into the system by the HIM Department. These documents are scheduled for destruction in the 60 days from scanning.

The former Director of HIM was successful in working with administration to get the EHR and imaging in place and to get approval to destroy the paper records. She failed at managing the day-to-day of the department. Now, the department has quality issues in the HIM functions. The former director also did a great job preparing the medical staff for the EHR, and the transition went smoothly; however, many physicians and other users are frustrated by the quality issues. Administration is also becoming concerned with the high billing hold report. The director's position was vacant for 5 months before the new director started work. She has only been here a month.

Today is your first day. The HIM Director has her instructions from administration and the medical staff. She has passed these instructions on to you. Your instructions boil down to two words-FIX IT. While the director will be actively involved in the clean-up, she cannot do it by herself with the other demands on her time. This is why she requested your position. It is almost unheard of for a new position to be approved in the middle of the fiscal year. Adding the extra position shows how serious administration is about getting the problems solved. The problems are as follows:

• Scanning:

o There is a 2-month backlog in scanning the paper records

o The quality of the scanning has problems

- Sometimes pages are fed two at a time, and the backs of pages are not always scanned.
- This requires 100% audit, which 3 months behind.
- The staff members conducting the quality audits do not catch all of the errors.

• Billing:

o The billing hold report is over $2,000,000.00.
o Administration wants the billing hold report held at $500.000.00.

• Coding:

o Coding is 2 weeks behind.
o There are three vacancies in the coding area.
o One of your coders is a new graduate of the local HIT program and is slower than the experienced coders.
o The last coding audit conducted by corporate showed an 80% coding accuracy report.

• Release of information:

o The release of information area is 2 days behind.
o The release of information area has received repeated complaints that the wrong information is being sent. The errors include:

- Not everything requested was released.
- Wrong admissions are being released.
- Information on wrong patients is being released.
- Wrong documents are being released.

• Transcription:

o An outsourcing company in used, since the hospital had trouble recruiting and retaining qualified transcriptionists.
o Although the transcription is current, the quality of work is inconsistent. Most of the reports are perfect, but a significant number of reports are totally inaccurate because of:

- Multiple typos
- Abbreviations that are not spelled out
- Poor grammar
- In some cases, wrong medications with names similar to right medications

Your assignment for this project is to develop a plan to solve the problems identified above and to prevent them and other problems from occurring in the future. Your plan should include AT LEAST:

1. Who should be involved
2. What reporting mechanism you should have
3. Who you should report to
4. What accuracy rates you expect
5. What you will do to solve problems (training, outsourcing, new policies, etc)
6. What will be monitored
7. Frequency of monitoring
8. Frequency of reporting
9. What investigations you will do
10. How you will build quality into your process
11. How you prioritize problems to be addressed
12. Forms
13. Graphs

Be creative, but use sound HIM principles as the foundation for your project. If you make assumptions, identify the assumptions in your narrative. Please take into consideration all aspects of the issues, including but not limited to legal, data quality, compliance, and quality improvement.