Case Study
HIM Department Rebuilt to Maximize Efficiency and Performance
With the speed and accuracy of health record processing
below desired levels, this not-for-profit hospital hired
B. E. Smith to assess and restructure its health information
management (HIM) procedures.
Frequent turnover of HIM directors – three in less than four
years – coupled with insufficient training on the hospital’s
electronic health record system had impeded the organization’s
efforts to operate an efficient, effective HIM department.
A B. E. Smith interim HIM director joined the team. In three
months, this seasoned professional assessed the department’s
challenges, designed strategies to improve performance, and
helped implement new processes to achieve positive change.
Specific Protocols, Comprehensive Training
Challenge: The hospital sought to improve its unbilled coding days,
a metric that should stand at about two days but in fact stood at 15
days and climbing. A record-scanning backlog (exceeding two days)
and imprecise chart reconciliation caused inconsistencies in document
naming that resulted in only some of the total discharged records
being handled by the HIM staff. Many accounts, inconsistently coded,
required correction before they could be dropped.
Solution: The interim HIM leader assessed chart processing
procedures and helped implement concrete changes. These
included initiating required timeframes for record processing,
such as retrieving ER accounts first thing in the morning and
routinely stipulating their processing by 9 a.m. Inpatient accounts
were now expected to be scanned into the system by noon,
while daily records, including outpatient surgeries, must be
completed by 4 p.m. The interim leader also initiated a thorough
chart retrieval process for all chart types. The leader began to
require a daily monitoring and correction of coding items, such
as missing registration information. The staff also began utilizing
census sheets to reconcile charts. The increased rigor surround-
ing chart processing enabled the organization to reduce unbilled
coding days from more than 15 to two, and to decrease A/R
days from 85 to 58.
Challenge: Faced with chart processing deficiencies and delays,
the hospital had attempted resolution by hiring additional staff.
But without comprehensive training, this led to an overstaffed
department still insufficiently prepared to achieve the desired
quality measures. A HIM department of six FTEs would be expected
to successfully support a 100-bed organization with about 22
inpatient discharges per day. Instead, 15 inconsistently trained
FTEs continued to struggle to process charts.
Solution: The B. E. Smith interim leader helped the hospital
understand that the hiring of additional staff – especially in light
877.802.4593
4 essential tips
B. E. Smith suggests the following tips to help healthcare leaders
maximize performance in the HIM department:
• Collaborate closely with staff. Take the time to truly understand
why deficiencies and inconsistencies occur.
• Provide comprehensive training in a formal setting. Ensure
leadership discusses proper protocols in detail and complements
training with well-documented supporting materials and guidelines.
• Build the staff up in their roles and empower them to understand their
important contributions to the organization’s overall success.
• Communicate successes – Collaboration between the HIM staff
and the medical staff helps to achieve shared goals.
by the numbers
Productivity and Accountability:
Reduced coded, Reduced A/R
unbilled days 27 days from 85 days
13 from more than
days
to 58 days.
days 15 days to
two days.
of a tight cash situation with less than 10 days of cash on hand –
did not actually contribute to resolution of HIM concerns. Instead,
the leader emphasized the critical importance of comprehensive
training to enable the optimal number of staff to be effective in
their roles. A formal training and certification program unfolded in
three sessions: chart reconciliation, scanning techniques and qual-
ity requirements, proper and consistent document naming and
classification. This thorough and consistent understanding of the
system and procedures equipped the staff with skills for success.
Challenge: A lack of confidence in the quality of record-keeping
caused concerns and morale issues. HIM staff did not feel suitably
empowered to fully function in their roles and the medical staff expe-
rienced doubts regarding the accuracy of medical record processing.
Solution: With comprehensive process guidelines and detailed
training opportunities now absorbed by the medical records
staff, the interim HIM leader initiated proactive communications
with the medical staff. The leader shared HIM’s goals, changes
and accomplishments and pledged to the medical staff that all ER
records would now be complete and in the system by a set time
each morning. Once clinicians began seeing this metric realized,
their confidence rose significantly, and their appreciation of the
HIM staff’s renewed efforts and commitment became evident.
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