Before moving toward an electronic patient record, a flexible, clinically
effective and operationally logical Medical Information Management System
should be developed. This system must efficiently capture information,
allow for the unique needs of clinical specialties, support reimbursement
and integrate all patient data for availability to all users.
The Need for Action
A Medical Information Management System provides a new approach to join the business needs of the institution to the realities of clinical care delivery. This is not only desirable from a visionary viewpoint, but necessary in light of an increasing level of third-party payor audits. Case by case, the auditor determines if the reimbursement equates to the resources used to treat the patient. That determination ultimately depends upon the clinical documentation that supports the level of care. It is possible with significant effort to rework and gather documentation for an audit, but it is far better to properly manage medical information from the moment the patient enters the system. Beyond the threat of significant income loss due to audits, the return on investment from the efficiencies gained will be substantial.The Goals
The consultants of Health Systems Management Network can develop a strategic and operational plan to bring your facility's disparate medical information services and systems into one logical and efficient system that supports billing/reimbursement, clinical care, clinical research and regulatory compliance. Immediate and long-term improvements in the documentation and medical record processes will increase efficiency and optimize reimbursement. Ambulatory care sites must be included in this plan to ensure that the medical record is complete and useful for all practice areas. The Electronic Patient Record is one ultimate form that this logical and complete system may take, but it is the streamlined methods and functionality of the underlying information structure that will yield the desired results regardless of the medium.
Methodology
Health Systems Management Network operates on two levels: the macro, or vision level, and the micro, or operational level. To achieve a systemwide overhaul of all medical information, it is critical that buy-in and leadership from the highest levels of the organization be obtained. Also essential is the involvement of the medical staff, because if the project's final outcome is not useful for care providers, the project will have failed. The development of an effective system must be founded on a complete assessment of the unique realities and operational details of the entire facility. Health Systems Management Network does not take an academic or theoretical approach. Instead, we work side by side with staff as we follow a set of patients through the system to analyze information capture and data flow. Through our long specialization in documentation, we have developed techniques for in-depth historical case reviews and case-mix analysis for accuracy and completeness, and for the strategic alignment between practice areas and the population served. By the end of our investigation we will have defined and flowcharted all critical functions involved in the development and use of medical information. Next, we will develop a detailed plan to move the institution toward a logical and versatile Medical Information Management System in line with an Electronic Patient Record that improves reimbursement for long-term return on investment. In addition, we will detail immediate ways to eliminate rework and redundancies in the system so that a return on investment in our services is achieved quickly.We
have a proven record of eliciting the support of physicians in some of
the world's busiest and most prestigious hospitals. We know how to recognize
and when to utilize the good work that already has been accomplished in
the institution. And we know how vitally important it is that the management
system is a valuable clinical tool, not another demand on staff time. This
only can be achieved with the direct involvement of care providers. The
involvement of the health-information professional staff is critical as
well, particularly as the information moves away from paper to electronic
formats.
Health Systems
Management Network also provides the final critical piece of the puzzle:
understanding of the needs and requirements of payors and regulatory agencies.
The Medical Information Management System must support the level of care
indicated on each patient bill. When successful, the protection of revenue
from audits will be substantial.
Before Moving to the Electronic Patient Record:
- Eliminate redundancies in the capture of information
- Improve flow of information to care providers
- Standardize and reduce the number of forms
- Determine and standardize the contents of circulating and permanent records
- Identify safe and efficient methods for storing and archiving records
- Eliminate rework of information
- Improve accessibility, accuracy and speed of medical word processing
- Reduce hard copy
- Meet the specific information needs of all clinical specialties and care centers
- Develop effective purge criteria
- Reduce physical management of records
- Reengineer medical information staff job descriptions
- Identify needed education and training
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