Perspectives in health information management / AHIMA, American Health Information Management Association最新文献

Northeast Alabama Regional Medical Center (RMC) in Anniston, Alabama purchased a smaller hospital in 2017. Staff at the two hospitals were tasked with merging the two Electronic Medical Record (EMR) systems into one unified system. From the outset, there were two systems with different medical record number specifications and patient identification systems as well as two different patient name parameters. The merging of these records and systems meant dealing with different vendor EMR systems and ancillary systems to produce a single unified record within RMC's EMR and the document imaging system that housed the legal medical record for each patient. This case study describes the process and procedures of merging the patient records from both hospitals to create one Enterprise Master Patient Index (EMPI); and the collaboration between the Health Information Management and Information Technology departments to accomplish this goal. It also reviews the impact and challenges related to the system's development, as well as lessons learned while completing the project.

Background: The implantable loop recorder (ILR) is valuable for recording and evaluating clinically relevant arrhythmias. Devices with wireless capabilities are programmed to automatically transmit data to a secure website for retrieval by cardiology staff. However, increased data review time, memory saturation, and overwriting of true arrhythmia episodes can result unless alerts are programmed to appropriately detect meaningful (or actionable) cardiac data. Patients are instructed to manually activate the ILR to initiate simultaneous recording of rhythms as part of routine, scheduled assessments or during symptomatic events. However, patients may feel overwhelmed or intimidated when attempting to generate their own cardiac data because of the large volume of new information and unfamiliar equipment instructions.

Objective: To determine if workflow changes and enhanced patient education improve the collection of more meaningful data from the ILR.

Methods: A retrospective chart review was conducted of rhythm data from patients with implantable Medtronic Reveal Linq cardiac monitors. Cardiac rhythm data were gathered three months before and after workflow changes to compare quality and quantity of remote transmissions.

Results: Significant improvements were noted following workflow changes and enhanced patient education. Scheduled transmissions increased, unscheduled transmissions decreased, and missed transmissions decreased per patient each month.

Conclusion: Workflow changes improved the quality of transmissions and decreased the quantity of transmissions. The capacity to provide high-quality care also improved, as evidenced by the ability to obtain more clinically relevant and actionable data.

Patient-centered care seeks to improve healthcare quality by engaging patients in their health management. Hospitals are employing strategies to enhance patient engagement to improve care quality, as measured by patient satisfaction through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Tablets are one tool hospitals use to increase patient engagement during hospitalization, as tablets can provide patients with access to both entertainment options and personal health information through patient portals. To explore the association between tablet access and patient satisfaction, data on tablet provisioning were linked to patient HCAHPS scores. Patients who were provided a tablet had higher HCAHPS scores in a subset of satisfaction measures, as compared with patients who were not provided a tablet, suggesting that tablets could positively influence patients' satisfaction with their hospital stay. Future studies are warranted to understand the specific ways in which tablet use improves the patient experience during hospitalization.

While nearly all hospitals have adopted electronic health record (EHR) systems, some are dissatisfied and considering replacement systems to better address unique organizational needs and priorities. With more than 4,000 certified health information technology products available, comparing the vast number of EHR options is complex. This study tested the hypothesis that various EHR systems demonstrate different financial and quality performance and presented a framework for comparison. Using a subscribed database containing US hospitals' observations from 2011 to 2016, we estimated an ordinary least squares regression model with robust standard errors and clustered by year. We regressed the selected finance and quality measures as dependent variables with the vendors' indicators as independent variables, with control variables. This study demonstrated an approach for analyzing performance data to help hospitals distinguish EHR systems on the basis of several organizational outcomes: return on assets, bed utilization rate, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) summary star rating, and value-based purchasing Total Performance Score. This framework will help EHR acquisition teams make informed decisions.

Technology is intended to assist with diagnosing, treating, and monitoring patients remotely. Little is known of its impact on health outcomes or how it is used for obesity management. This study reviewed the literature to identify the different types of technologies used for obesity management and their outcomes. A literature search strategy using PubMed, CINAHL, Scopus, Embase, and ABI/Inform was developed and then was vetted by two pairs of researchers. Twenty-three studies from 2010 to 2017 were identified as relevant. Mobile health, eHealth, and telehealth/telemedicine are among the most popular technologies used. Study outcome measurements include association between technology use and weight loss, changes in body mass index, dietary habits, physical activities, self-efficacy, and engagement. All studies reported positive findings between technology use and weight loss; 60 percent of the studies found statistically significant relationships. Knowledge gaps persist regarding opportunities for technology use in obesity management. Future research needs to include patient-level outcomes, cost-effectiveness, and user engagement to fully evaluate the feasibility of continued and expanded use of technology in obesity management.

During residency training, one of the tools residents learn to use is the electronic health record (EHR). The EHR contains up-to-date medical data that are crucial to the care of the patient; thus the provider must know what is pertinent, where to locate it, and how to efficiently document the data for ongoing communication of patient care. Because institutions may have different EHR vendors, EHR workflow study data are often obtained in single institutions, with a limited number of participants and specialties. Increasing our understanding of the subtleties of residents' EHR usage not only can help educators understand how residents use the EHR but also may provide information on another cognitive factor to assess residents' performance. This, however, will only occur when EHR skills are considered an important part of residency training and we ask our EHR vendors to help us develop validated electronic tools to assess EHR performance.

This is a case study of the evidence-based management practices of a centralized health information management (HIM) department in a large integrated healthcare delivery system. The case study used interviews and focus groups, as well as de-identified dashboards, to explore the impact of reporting on the organization. The dashboards and key performance indicators (KPIs) were initially developed in 2012 and have continued to evolve. The themes that resulted include the following: (1) evidence-based management is integral to the culture of the organization; (2) communicating regularly via dashboards and KPIs is key to transmitting the value of HIM to the entire organization; and (3) staff not only report the required measures for the dashboard but also take pride in it and often develop methods for tracking their individual performance. Most evidence supporting HIM operations management is related to coding and clinical documentation improvement, but even in those areas, national benchmarks are missing. It is important for the HIM profession to develop national and regional benchmarks to assist professionals in managing operations effectively and communicating their value to the healthcare industry.

As health information management (HIM) shifts from paper-based medical records to electronic medical documentation, HIM professionals must appropriately manage their resources to produce higher results for their organization's operational and financial indicators. This case study highlights the experience of the HIM department in a small Florida community hospital in analyzing existing productivity standards and developing new standards with the purpose of improving the document imaging process. The research produced new productivity standards that more accurately represent the time HIM technicians spend performing their everyday tasks. The data collected during this period indicate that the average HIM technician was prepping 844 images an hour, scanning 601 images an hour, and indexing 482 images an hour. While a trend in productivity cannot be identified because different types of data were collected, the department's standards are now based on more consistently measurable output. The data collected during this study were used to manage the continuously changing workflow processes; improve the staff's knowledge, skills, and abilities; and identify potential areas of process improvement.

Although the federal electronic health record (EHR) incentive program has ended, the need to effectively implement and use EHRs has not. The advent of the federal Quality Payment Program (QPP) has made effective use of EHRs more critical than ever, especially for clinical quality measurement and improvement. However, practices continue to face challenges in successfully implementing and using EHRs to achieve these aims. We used a multiple case study approach to understand how physician practices were using EHR data to measure and improve quality. We interviewed a variety of physicians and staff at multiple practices of diverse sizes and settings. Our findings suggest specific approaches that can help practices better harness their EHR data to measure and improve the quality of care while reducing or preventing staff dissatisfaction and burnout. These lessons can help practices better leverage their EHRs to succeed in the QPP.

On October 1, 2012, as part of the Affordable Care Act, the Centers for Medicare and Medicaid Services began to reduce payments to hospitals with excessive rehospitalization rates through the Hospital Readmissions Reduction Program. These financial penalties have intensified hospital leaders' efforts to implement strategies to reduce readmission rates. The purpose of this multiple case study was to explore organizational strategies that leaders use to reduce readmission rates in hospitals located in a non-Medicaid-expansion state. The data collection included semistructured interviews with 15 hospital leaders located in five metropolitan and rural hospitals in southwest Missouri. Consistent with prior research, the use of predictive analytics stratified by patient population was acknowledged as a key strategy to help reduce avoidable rehospitalization. Study findings suggest that leveraging data from the electronic health records to identify at-risk patients provides comprehensive health information to reduce readmissions. Hospital leaders also revealed the need to understand and address the health needs of their local population, including social determinants such as lack of access to transportation as well as food and housing.