Overview The field of health information management (HIM) is complex and diverse

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Overview
The field of health information management (HIM) is complex and diverse, and as such, HIM professionals work across several different settings and job titles. HIM professionals are highly trained in the latest information-management technology applications and understand both the clinical and technical workflow in healthcare organizations. They are vital to the daily operations management of health information and electronic medical records (EMRs). They ensure that a patient’s health information and records are complete, accurate, and protected. They often serve in bridge roles, connecting clinical, operational, and administrative functions. These professionals affect the quality of patient information and patient care at every touch point in the care of patients. HIM professionals must have knowledge of how all parts of the healthcare delivery cycle function.
As a professional in the HIM field, you will be tasked in this assessment with handling the multiple complexities of implementing an EMR at Shoreline Health System (SHS), mimicking all the considerations and issues of a real-life implementation. Such an undertaking requires research, understanding of the current environment at SHS, financial evaluation, and engaging invested stakeholders. Beyond justifying your choice of EMR vendor, you will also assess how such implementation will meet the complex needs of SHS by meeting required standards. Knowing that your educated opinion will be essential to how the system is implemented, you will be required to present your proposal as a PowerPoint presentation, as if you were presenting the topic to the SHS Board of Directors.
Review this case study for detailed information about SHS. The information in this case study is essential for completing your final project.
HIM 480 Shoreline Health System Case Study
Profile of Shoreline Health System
Shoreline Health System (SHS) is located in coastal South Carolina in the United States. It is a teaching and research affiliate of the University of Southern Carolina in Columbia, South Carolina, and serves the broad coastal region as well as referrals from surrounding states in specialty care areas. It employs approximately 10,000 people and consists of five hospitals, including three general hospitals, a pediatric facility, and a women’s care institution. Likewise, SHS is an integrated delivery network with a wholly owned health plan (SHS Health) that covers approximately 400,000 members regionally.
SHS also owns long-term care facilities and a mail-order pharmacy. There are 250 employed physician practices, half of which are specialists and half of which are primary care practices. Likewise, there are another 100 regional practices that are not owned by SHS but refer over 70% of their cases to SHS hospitals and clinics. Specialists focus on both clinical care and research with nationally renowned programs in endocrinology, heart disease, and gynecology-oncology. Section 1: EMR Implementation and Current State of SHS
SHS would like to convert all their facilities to the same electronic medical record (EMR) system in order to better coordinate care and communicate throughout the health system. It is particularly important to SHS to implement a total inpatient and ambulatory electronic record for documentation, ordering, results review, admissions, and discharge. They want to get all of the current members of their practice into the system. They would also like to have a patient portal so that patients can access their information. SHS has received two proposals from EMR companies to implement such a system. The hospital’s current admissions and discharge, billing, and registration system is a decades-old upgraded mainframe product called Medipac, which has trouble interfacing with most newer EMRs. The hospital also has electronic pharmacy, laboratory, and radiology systems, but each is a standalone system.
There are other information systems at SHS. A best-of-breed master person index (MPI) product called Initiate is in place to handle both patient/person and physician master file management and identification. The commercial product called Cloverleaf runs as an HL7-based integration engine running billing, registration, results, and MPI interfaces between the different information systems. The chief executive officer (CEO) at SHS, Jim Bradley, is very concerned about the competitive threats in the region and their potential impact on ambulatory and specialty patient volumes at SHS. He would like to see SHS positioned to use its IT environment strategically to offer innovative solutions to the community in order to maintain and possibly grow new market share. The chief information officer (CIO) is Margaret Fry. There are physicians who volunteer their time to work on IT projects, but there is no formal physician IT structure. There is a physician representative of the medical executive committee, Dr. Joe Brown, who has organized the group of physicians to pilot new EHR systems. Other physicians on the committee feel that it would make more sense for SHS physicians to keep their current physician office systems. Section 2: Interoperability Standards
The employed SHS physician practices have many different physician office systems that mostly do registration, scheduling, and billing with clinical practice run on paper charts. A few have implemented their respective vendors’ EMR systems for orders and electronic prescribing but are not able to currently meet the clinical requirements for interoperability standards in the outpatient setting. Many of these physicians prefer to stay on their current platforms but recognize that they cannot meet interoperability standards without implementing these vendors’ electronic health records, which would include expensive interfaces to SHS systems. While the investment would be sizable, these physicians feel as though there is a justification to implementing one ambulatory electronic health record along with the inpatient record. They see colleague physician practices in other states that have optimized billing receivables even more by installing Epic’s clinical modules. They are also worried that they currently do not have secure HIT mechanisms for patient outreach to meet interoperability standards given the current systems in the SHS physician offices.
Section 3: Current Health Information Management (HIM) Environment
Currently, the inpatient HIM department at SHS works well in tandem with the information service steam and the physician staff in general. The inpatient HIM leadership has also established a matrix reporting relationship with HIM and office management staffs in the SHS physician offices that manage medical records. Generally speaking, most HIM quality metrics that can be measured for the inpatient SHS environment are within quality goals for this year; chart completion percentages are in line with HIM quality goals, with 80% of charts being complete within 20 days post discharge. Record releases are within projects of8,000 records per month inpatient and 15,000 records per month across the outpatient practices. Recent audits examining quality metrics, such as presence of H&Ps on operative charts and presence of all externally scanned documents in the Epic inpatient record, showed between 98.5% and 99.1%compliance.
Coding and Documentation Issues, Surgery: One recent area of concern that is taking up a lot of time on the part of the HIM coding supervisor is the number of physicians inquires that coding staff members must do with regard to physician documentation in the Epic record that does not match coding. These cases are coming back as errors in the 3M-quality management claims scrubber system and holding up claims. There is a suspicion on the part of the HIM department that physicians are using the cut-and-paste function in Epic excessively and forgetting to update documentation appropriately. The general same-day surgery areas have the highest volume of issues in this area. The HIM leadership and finance teams have done root cause analyses and determined that this issue is affecting inpatient days in accounts receivable, increasing days from the goal of 42 days to 43.5 days as of the last six months.
Section 4: Financial Environment
Current State Financial Information: Currently, the physicians’ offices as a whole at SHS make approximately a 5.5% profit margin net billing per year, which is reinvested into physician incentives and necessary capital upgrades—equipment, facilities, and information systems. Historically, this 4-capital margin has been approximately $5,000,000 per year. However, given concerns over losing ambulatory volumes to competitors this year, the CFO is projecting this capital margin to be $4,500,000. Of this margin, $500,000 is allocated toward facilities and equipment upgrades for the physician practices. Recognizing the competitive concerns and need to meet CMS MU and billing regulations through a comprehensive health information management strategy, the SHS board of directors has allocated a one-time $4,000,000 capital expenditure for the ambulatory electronic medical record investment for this fiscal year. Itisprojectedthatthiscapitalexpenditurewillbespentoveraone-tothree-yearperiod. Currently, the total annual operating budget to run the disparate ambulatory information system platforms in the SHS physician offices is $700,000, including the detailed breakdown of costs below. There is currently no capital technology expenditure for SHS physician practices.
•Software maintenance/support: $300,000
•Hardware maintenance/support: $200,000 •Support/post-production salaries: $150,000
•Other (miscellaneous training and so on): $50,00
The project is divided into two milestones, which will be submitted at different points in the course to scaffold learning and ensure a quality final submission. These milestones will be submitted in Modules Three and Five. The final product will be submitted in Module Seven.
This assessment will evaluate your mastery with respect to the following outcomes:
Apply health data structure, standards, and regulations to manage clinical classification systems and reimbursement
Analyze the uses, risks, and management of health statistics and biomedical research data and their support to performance-improvement programs
Interpret and apply current laws, regulations, policies, and healthcare ethics as they relate to decision making in healthcare delivery and systems
Implement and manage hardware and software technologies to ensure effective data collection, storage, analysis, and reporting of information
Evaluate information system applications (databases, selection processes, service applications, etc.) for their capacity to meet the needs of healthcare organizations
Using current management principles and recognizing limits on human and financial resources, propose solutions and develop project management plans to solve organizational challenges
Prompt
Create a health information management proposal for the SHS Board of Directors. This proposal should take the form of a PowerPoint presentation that you would deliver to the SHS technology subcommittee of the SHS Board of Directors with regard to the proposed EMR pilot project. In your presentation, you must address any relevant HIM problems currently happening at SHS, ways in which this investment might address these issues, a cost proposal for the pilot project, and closing thoughts related to change-management strategies for physician adoption of the new ambulatory electronic record, if the pilot is successful and SHS adopts a common ambulatory EMR. You should use appropriate evidence to support your presentation and should include comprehensive speaker notes.
The following sections should be included in your PowerPoint presentation:
I. Goal Statement: Provide a 2- to 3-slide overview of the current state of the organization in regard to current legal and financial risks, accreditation concerns, ethical issues, and technology needs. You will consider the current goals of the organization and the need for the transition to the ambulatory EMR. Think about the information that key stakeholders would need. (Completed 21 Jul 24 Milestone One #412908123)
II. Financial Considerations: Create a department budget for the implementation of the ambulatory EMR. (Completed 21 Jul 24 Milestone One #412908123)
a. Analyze the budget to inform strategic decision making.
b. Consider the financial impact by discussing the operational metrics to be considered.
c. Detail the potential risks for the investment.
III. Proposed Information Technology Plan: Provide a comprehensive information technology plan for implementing the ambulatory EMR. (Completed 28 Jul 24 Milestone Two #413490442)
a. Recommend a vendor by using a vendor-selection process for a new EMR, and explain why this vendor will improve accreditation requirements, reimbursement, legal and ethical concerns, audit controls, and patient safety compared with other options.
b. Develop a strategy to approach vendor negotiation to reduce costs and uphold quality.
c. Describe accreditation standards relevant to the implementation of the EMR.
d. Prepare a contingency plan in the event of system downtime.
Implementation Plan: (Completed 28 Jul 24 Milestone Two #413490442)
a. Prepare a change-management strategy to effectively implement the ambulatory EMR.
b. Prepare an appropriate project management tool to demonstrate the timeline of the implementation.
c. Develop a training for staff for compliance with safety and security laws.
d. Detail the reporting of the information plan for accreditation status.
Evaluation Plan: Since you will not execute the campaign, it cannot be measured. But you can still create the measurement plans in advance. Discuss specific quality assurance plans to measure improvements in the HIM problem areas before and after the EMR implementation. Consider forming a stakeholder team to consider key strategic initiatives. (This must be completed)!
Milestone One: Goal Statement and Budget
In Module Three, you will submit a draft of the goal statement and budget proposal. This milestone will be graded with the Milestone One Rubric.
Milestone Two: Information Technology Plan and Implementation Plan
In Module Five, you will submit a draft of your information technology plan and your implementation plan. This milestone will be graded with the Milestone Two Rubric.
Final Submission: Shoreline Health System (SHS) HIM Proposal to the Board of Directors
In Module Seven, you will submit your final project. It should be a complete, polished artifact containing all of the critical elements of the final project. It should reflect the incorporation of feedback gained throughout the course. This submission will be graded with the Final Project Rubric.
What to Submit
The PowerPoint presentation should include 12–15 slides (in addition to a cover slide and reference slide) with comprehensive speaker notes. The reference slide should contain six to eight resources, five of which should come from peer-reviewed literature based in research. The presentation should include APA-style citations.
The “Possible Indicators of Success” are examples for you and the instructor of the types of concepts to look for to demonstrate proficiency. They are neither exhaustive nor prescriptive and should be used as guides for illustrating how your capstone embodies the outcome. All outcomes are weighted equally.
Possible Indicators of Success
I. Apply health data structure, standards, and regulations to manage clinical classification systems and reimbursement
• Does the student demonstrate the ability to articulate national data standards and regulations and their impact upon healthcare facilities?
• Does the student demonstrate the ability to speak to types of clinical classification systems and their importance?
• Does the student demonstrate the ability to connect the collection and quality of data with reimbursement and healthcare finance principles?
II. Analyze the uses, risks, and management of health statistics and biomedical research data and their support to performance-improvement programs
• Does the student demonstrate the ability to illustrate the important data points required to come up with relevant health data to guide program development?
• Does the student demonstrate the ability to interpret the meaning of health statistics or data outcomes?
• Does the student demonstrate the ability to evaluate resources needed to effectively implement the research projects and performance-improvement programs?
• Does the student demonstrate the ability to work collaboratively with leadership and other key figures in the project’s development and implementation in designing and delivering an effective initiative?
III. Interpret and apply current laws, regulations, policies, and healthcare ethics as they relate to decision making in healthcare delivery and systems
• Does the student demonstrate the ability to assess federal and state regulations relevant to the project and their potential impacts?
• Does the student demonstrate the ability to use evidence-based ethical decision making and critical thinking to support outcomes and goals?
• Does the student demonstrate the ability to address potential ethical challenges?
• Does the student demonstrate the ability to employ communications skills that consider and are sensitive to stakeholders and those impacted by the initiative?
IV. Implement and manage hardware and software technologies to ensure effective data collection, storage, analysis, and reporting of information
• Does the student demonstrate the ability to understand how data collection and storage methods will impact stakeholders in the organization?
• Does the student demonstrate the ability to identify a target population impacted by a change in a system?
• Does the student demonstrate the ability to develop a project timeline and establish goals?
V. Evaluate information system applications (databases, selection processes, service applications, etc.) for their capacity to meet the needs of healthcare organizations • Does the student demonstrate the ability to choose best system applications by evaluating the needs of the healthcare organization?
• Does the student demonstrate the ability to identify a target population impacted by change in a system?
• Does the student demonstrate the ability to develop a project timeline and establish goals?
VI. Using current management principles and recognizing limits on human and financial resources, propose solutions and develop project management plans to solve organizational challenges
• Does the student demonstrate the ability to integrate the organization’s mission, vision, and values into the project goals?
• Does the student demonstrate the ability to identify limits in resources when implementing project goals?
• Does the student demonstrate the ability to evaluate needs and formulate project management plans within the changing world of healthcare?
• Does the student demonstrate the ability to list considerations for future iterations or needs of the implementation?
• Does the student demonstrate the ability to collaborate with others working toward a common healthcare goal?
Final Project Rubric
Course Outcome Progress Toward Meeting the Outcome
Apply health data structure, standards, and regulations to manage clinical classification systems and reimbursement Proficient (100%) Not Proficient (0%)
Analyze the uses, risks, and management of health statistics and biomedical research data and their support to performance-improvement programs Proficient (100%) Not Proficient (0%)
Interpret and apply current laws, regulations, policies, and healthcare ethics as they relate to decision making in healthcare delivery and systems Proficient (100%) Not Proficient (0%)
Implement and manage hardware and software technologies to ensure effective data collection, storage, analysis, and reporting of information Proficient (100%) Not Proficient (0%)
Evaluate information system applications (databases, selection processes, service applications, etc.) for their capacity to meet the needs of healthcare organizations Proficient (100%) Not Proficient (0%)
Using current management principles and recognizing limits on human and financial resources, propose solutions and develop project management plans to solve organizational challenges Proficient (100%) Not Proficient (0%)
Total: 100%

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