You are the HIM Manager at Davenport University Hospital. It has a workflow process that has been working relatively well for years; however, with the transition from paper to electronic records, they are running into some issues. The new CFO wants the DNFB to be less. It tends to run around $2million, and she would like it to be under $700,000. The coding area has been identified as the reason that bills are not dropped within 3 days of discharge. While your facility is transitioning to the EHR, some of your doctors still want the paper chart to dictate from, and they state that the charts are not available for them to access immediately after discharge. Your task is to speed up the process. The charts need to be coded faster and the paper charts need to get put together faster. You must redesign the workflow. The current process is as follows: • Charts are picked up on second shift anywhere from 10pm to midnight on the day the patient is discharged. • Charts are checked off the discharged list as they are brought into the department at that time. • The charts go to the “waiting” area and they wait there for any loose paperwork to come down. The electronic record is helping this; however, it has not solved this problem as 80% of our doctors want the paper chart to look at as well. • Materials are added to the record for the next 3 days then the chart is routed to coding on day 4. • After being coded, they are assembled on day 5, then analyzed on day 6. • Day 7 is when abstracting is completed. Then the chart goes to the incomplete area or permanent filing area.

Answer the following questions (The paper should be 1-2 pages in length). 1. Identify the areas of concern in the current workflow. Offer recommendations for improvement in the workflow process that will help achieve the goal of lower DNFB. The recommendation should state what position is responsible for the new process. For example: analysis clerk will pick up the charts at X time. 2. What potential positive and negative impacts do you expect with the process and personnel including physicians? 3. Discuss performance measures and how they could positively or negatively impact your recommendations. 4. What could you do to decrease any negative response to your recommendations?