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Miami Dale College FCHs EHR Full Digitization Project Business Case Study

Fielder Community Hospital Scenario Fielder Community Hospital (FCH) has five campuses. Each campus is in a different geographical location: North (rural), South (suburban), Downtown (metropolitan/city center), Children s (metropolitan/city center), and Long-Term Acute Care (LTAC) (suburban). There are 227 physicians, physician assistants (PAs), and nurse practitioners (NPs) at FCH. Many of these individuals see patients at all five facilities. Each campus currently uses a hybrid medical record and stores paper records at each of their respective facilities. Health information management (HIM) staff are responsible for retrieving records from the floor of each facility and carrying them back to the facility s HIM department for indexing and scanning. FCH leadership has budgeted $4,000,000 to transition to a fully digital electronic health record (EHR). They have selected Synesthor EHR as the vendor. This allocation is only enough money to meet the requirements to remain compliant and does not cover the costs of investing in cutting-edge technology. The hospital will also be merging the HIM department from each campus into one centralized location. Currently, each of the five HIM departments has a director, with subdepartments to support release of information (ROI), coding, and deficiency tracking/data management duties. Departmental staffing has traditionally been structured per facility. Each department will be merged into one centralized location, under the leadership of one HIM system director. The new centralized space will hold 125 people (reference the Current HIM Staff table), with room for 10 percent growth. The number of employees is expected to increase with facility growth. The facilities with 35 or fewer employees move at a slower pace due to the patient volume and size of the facilities. The facilities with more than 50 employees are fast-paced and numbers-driven. Of the five facilities, only the South facility has great patient satisfaction scores. The Downtown facility is one of the larger facilities and has very low patient satisfaction scores. The other facilities have scores that need improvement. The South facility, that scores well, does not want to be associated with the poorly scoring and mediocre facilities. New leadership in FCH supports remote work for the coding and revenue cycle positions. Remote employees will need new laptops, telephones, and VPN access to the EHR. This will cost $2,100 per employee. In-house employees will need new desktop computers and telephones because the current equipment is outdated. This will cost $2,700 per employee. (See the operational budget.) The HIM system director, HIM managers, and HIM supervisors will be responsible for training the employees, and this training on the new EHR system will occur during work hours. In the current hybrid system, productivity fluctuations are due to patient volume. In the new system, productivity fluctuations are anticipated to be in intervals due to employees spending extra time training and because of the learning curve associated with operating in the new system. Some employees have been in the 1 department for over 20 years and are not as technologically savvy as the newer employees, many of whom are recent graduates. HIM Staff FCH Leadership: Hospital leadership suites are located at the North campus, and most business is handled virtually. The leadership team does not have a personal relationship with the employees at the other campuses, and they are not aware of the cultural differences among employees. Leadership is currently working to implement several major projects: transitioning from a hybrid to a fully digital EHR, merging the five HIM departments into one centralized department, and moving employees from working inhouse to working remotely. Physicians: The hospital has encountered difficulty recruiting young physicians due to antiquated technology and processes. The transition to the new EHR will improve recruiting efforts by providing more efficient and productive technology. The seasoned providers (physicians and nonphysician practitioners) have expressed resistance to the transition to a fully digital patient record due to the time required to train. These seasoned providers believe that patient care will be affected as they train on new skills outside of their traditional roles. HIM Leadership: Training on the new EHR will cause downtime within the departments that will affect the organization s revenue stream. Each department director will work with the new HIM system director to create downtime procedures to ensure essential functions are completed during the transition period. Management will also have to reassign roles for positions that will become obsolete. HIM Staff: There has also been resistance to the transition to the new EHR from the HIM staff. The staff are concerned about the possible reassignment of duties and reduction in staff. This fear has affected their daily work performance and morale. Some employees are threatening to quit or retire because of the changes that are expected as a result of transitioning to a fully digital record. As with the physicians, there are seasoned employees and new graduates who have different opinions about the transition. The HIM staff are responsible for developing downtime procedures for the six-month duration of the project. Things to be considered include the potential of losing staff, the reassignment of many current staff to new roles, and the learning curve of adapting to the new processes. Employees need to expect a learning curve. They will need time to adjust to the new processes and become acclimated in the new system. The new system will also require staff to perform system maintenance and resolve problem tickets. Currently, there is no additional compensation for transitioning into a new or different position. 2 HIM staff that previously completed manual tasks such as picking up records from the floor, sorting the records, scanning the records, and storing old records for 90 days before destroying them will now complete digital administrative tasks. These digital tasks include ensuring digital records are complete and assigning them to a work queue if additional signatures or authorization is needed before they are sent to Revenue Cycle Services. This will cause a reduction in staff. There is no grandfather clause that will automatically allow employees to keep their positions. Current HIM staff will have to interview for the new HIM positions. Release of Information (ROI) staff will no longer have to print and fax records as they did in the old system. Now they will be able to fulfill record requests directly from the new EHR. o This will cause a reduction in staff needed in this role. Current ROI staff will have to interview for the new HIM technician positions. o Those who are not chosen will remain to scan paper records on a six-month contract. At the end of the six months, they can either transfer to another department or accept a three-month severance package. Deficiency Tracking/Data Management staff will no longer assign deficiencies and take paper charts to the incomplete room. Deficiency analysts in the digital system will assign deficiencies and will serve as a liaison between the HIM department and clinicians in support of optimizing the EHR workflow. Physicians currently have incomplete paper records at multiple sites. Once the EHR system is implemented, physicians will have a mix of incomplete paper and digital records until all paper records are signed and complete. They will perform deficiency assignments by sending them to the provider s inbox in the system. They will also work on transcription errors and missing documentation work queues. o This will cause a reduction in staff. Current Deficiency Tracking/Data Management staff will have to interview for the new HIM deficiency analyst positions. o Those who are not chosen will remain to scan in paper records on a six-month contract. At the end of the six months, they can either transfer to another department or accept a three-month severance package. A new Clinical Documentation Improvement team will be located in the centralized location. There will be four new positions created for this team. They will be able to work onsite or remotely. This will be a lateral move for the coding staff. The salary for the new positions will come from the existing allocation for the Revenue Cycle staff. o The role requires a Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA) credential and five years of experience. 3 o Seven of the current coders are considering this position, yet only three are academically qualified, possessing an RHIT or RHIA. The remaining four coders hold a Certified Professional Coder (CPC) certification, and they have been with the organization for over 10 years. They are also familiar with the physicians. Leadership must consider that some patients have records in the master patient index (MPI) for more than one hospital campus. This means they have multiple medical record numbers. Staff will be needed to help consolidate the MPI. Leadership must also consider that the backup server and microfiche are currently housed off-site. The centralized location will add over an hour to the commute for some employees. A retrieval policy will need to be created. The HIM directors do not feel like they had ample time to inform their staff of the merger and the possibility that some positions would be realigned or changed to a remote status. The directors will be reorganized after the merger and will become functional managers. As functional managers they will oversee the operations of a unit of a department in the organization. They will ensure that projects are completed on time and according to budget. Their compensation and responsibilities will not change. They are not happy about being demoted from directors to managers. 4 HIM Director Profiles Photo Name and Title Emma Lane, RHIA South director Kelly Vasquez, MHL, RHIA Downtown director Background and Leadership Style Background: Emma is a recent graduate, trying to learn the field and get acclimated to her job. She understands the transition and supports it because she is ready to meet new people and work with more experienced managers. Leadership Style: Emma leads with a very relaxed leadership style and allows employees the freedom to do their work without her overseeing their day-to-day operations. She allows a flexible schedule if employees work their hours and get work done. She is open to a flexible schedule or remote work where possible. She works remotely two to three days a week. Emma also tends to show favoritism toward certain employees within her department. Background: Kelly recently moved from another state. She does not mind relocating and supports the change. She has experience with departmental and organizational mergers and thinks this is a great next step. Leadership Style: Kelly leads her employees using a laid-back style, and she trusts employees to do their work on time without constant guidance and supervision. However, she is always available to guide when needed. She prefers that employees resolve their work-related differences amongst themselves. 5 Marty Sanchez, RHIT Children s director Background: Marty is an internal employee who has been with the department and worked his way up to his current position. The organization paid for his education. He intended to get his undergraduate degree and one day retire from the company, but now he is not so sure. He feels the company is not considering the employees in the move. He is also worried about working collaboratively with the other directors because he has the least amount of formal education. Leadership Style: Marty leads with an authoritarian leadership style and likes employees to stay on task and maintain a high level of productivity. Marty prefers that his employees to come to him if they have work-related disagreements. Jenna Crumpton, RHIA, CCS North director Donna King, MBA, RHIT Long-Term Acute Care (LTAC) director Background: Jenna has been with the company for over 15 years. She is not happy about the move to a centralized location due to the extended commute. She will have to travel over an hour to work. Leadership Style: Jenna is a very flexible manager, and due to her concerns with commuting and the need for flexibility is very open to flexible schedules for her employees and telecommuting. She will help resolve employee conflict if asked to intervene but otherwise lets employees resolve issues themselves. Background: Donna has been with the company for over 20 years. She is not happy about the move to a centralized location, and she does not want to learn the new technology. She fears her job will be eliminated. She is considering retirement. Leadership Style: Donna is a very hands-off manager and does not worry too much about employee productivity. She does not encourage change. She allows her employees to work at their own pace and can sometimes get involved in employee conflict, which creates more drama for the department. 6 Organizational Culture There are notable cultural differences between the facilities and staff. This will require cultural sensitivity training. Not only will the staff have to learn to coexist, but they will also have to deal with cultural differences among patients. 1. The employees in the South and LTAC campuses have been with the organization for many years. They live close to the facilities and use a minimal amount of technology in their current work. 2. The employees in the Downtown and the Children s locations are generally younger. Many employees are recent graduates, and most are technologically savvy. 3. Many of the employees at the South campus are nearing retirement age and generally depend on their director (a recent graduate) to work with the technology. They do not have the funding or facilities for a new digital EHR. 4. The employees at the Downtown and the Children s campuses do not want to leave the convenience of their current location. They currently work near eateries and shops, and they love the hustle and bustle of the city center. 5. The employees at the LTAC, North, and South campuses generally do not like the people in the city. Many of the rural employees also do not feel comfortable driving in city traffic. 6. Some staff members have a hard time getting along because some have been employed for 20 years and others have been employed less than a year. The seasoned staff members feel the new staff members are taking over their jobs. 7. The North and LTAC facilities serve many older patients who use Medicare. The Children s campus serves children who are on Medicaid. The Downtown location serves more Level I trauma (gunshot wounds, burns, and motor vehicle accidents) patients who do not have insurance. The Downtown facility also serves more vulnerable populations (e.g., LGBTQIA+, homeless, mentally ill). The South campus is more of a boutique hospital that frequently serves short-stay patients and noncritical illness. The facilities in the city (the Downtown and Children s campuses) typically have more culturally and ethnically diverse patients. 8. In general, the employees are not excited about working with different kinds of people. Some younger employees with more education look down on the older employees with experience. 9. Older employees feel like their services are no longer needed, and many are considering retirement or resignation. Younger employees are often boastful about the new ways of 7 doing things. 10. Some of the staff prefer meeting in person while others prefer meeting virtually. The staff who prefer meeting in person appreciate the fellowship and camaraderie that comes from having relationships with their coworkers. The staff who prefer meeting virtually typically do not value personal relationships with their coworkers and think talking about their personal lives should be left out of the work environment. Organizational Goals The organization s strategic goals include the following: 1. Improve the patient experience. 2. Measure productivity and report quality performance. 3. Adapt to new payment-managed care models. Based on the organization s strategic goals, the department goals include the following: 1. Increase remote work with leadership support. 2. Increase productivity standards for analysis, transcription, etc. (this depends on job roles and monthly productivity). 3. Train all staff on the new EHR system. 4. Improve patient experience after the departmental merger. This includes release of information (ROI) turnaround time, coding accuracy (billing on time), deficiency reduction (billing on time), and patient portal satisfaction (education). 8 EHR Implementation Budget Name Cost Units Total Notes EHR vendor software licenses $325,000 5 $1,625,000 Touchscreen workstations (physician iPads) $1,500 227 $340,500 Each MD, PA, and NP will receive a device. Desktop workstations (clinical staff) $2,000 680 $1,360,000 This does not include HIM department workstations. Electronics/power backup $3,500 25 $87,500 Network electronics $350 45 $15,750 Servers $2,000 6 $12,000 Project management (vendor cost labor plus travel per consultant) $6,500 12 $78,000 Installation (labor) $45,000 1 $45,000 Installation (equipment) $22,000 1 $22,000 Training (vendor cost labor plus travel per consultant) $6,500 7 $45,500 9 Software configuration package $10,500 1 Total Implementation Cost $10,500 $3,641,750 Operational Budget (New centralized location) Telephone (on-site and remote, per employee) $500 Office supplies (per department) $1,500 Laptop (remote, per employee) $1,600 Desktop (on-site, per employee) $2,200 Scanner (x4) $8,500 Copy machine $4,000 10 Current HIM Staff Location North (Rural) South (Suburban) Downtown (Metropolitan/City Center) Children s (Metropolitan/City Center) LTAC (Suburban) Position Totals Salaries HIM Directors HIM Supervisors Coding Staff (Coder I and II) Release of Information Staff Deficiency Tracking/Data Management (HIM Tech I and HIM Tech II) 1 3 20 6 20 50 1 3 12 4 15 35 1 4 22 8 25 60 1 2 8 3 16 30 1 1 6 2 12 22 5 13 68 23 88 197 $80,000 $65,000 $52,000 $47,000 $38,500 Total Employees 11 [ TITLE ] BUSINESS CASE PREPARED BY DATE Page 1 of 5 BUSINESS CASE PROJECT DETAILS PROJECT NAME Proposal Date Project Lead Executive Sponsor Department PROBLEM/SITUATION/BACKGROUND Problem definition Current process explanation Performance issues explanation CAUSE OF THE PROBLEM Fishbone Diagram SOLUTION Benefits Workforce Impact Department Impact PROJECT DEFINITION GOALS AND OBJECTIVES Page 2 of 5 Goal 1 Objective 1 Goal 2 Objective 2 Strategic Impact (how the project contributes to the organization s goals) PROJECT SCOPE Deliverables Timeline Budget PROJECT STAKEHOLDERS Stakeholder Role Responsibilities * Add or remove rows as needed. RACI Chart In the chart below, enter the appropriate letter for the role that will be responsible, accountable, consulted, or informed (based on the following definitions) for each deliverable/task. R = Responsible for completion of task or deliverable A = Accountable for completion and approval of the task C = Consulted by those responsible for advice and expertise I = Informed, kept updated on progress and notified when tasks are completed ROLES Deliverables [Role Title] [Role Title] [Role Title] [Role Title] [Role Title] Deliverable/Task #1 Deliverable/Task #2 Deliverable/Task #3 Page 3 of 5 Deliverable/Task #4 Deliverable/Task #5 * Add or remove rows and/or columns as needed. PROJECT RESOURCES Peopl

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