Fail-Safe: HIM Experts are Essential Early in the IT Adoption Cycle

By Mary Butler

The COVID-19 shelter-in-place orders that swept the country this spring compelled many healthcare organizations—some, for the first time ever—to quickly adopt and scale virtual services solution.

Some providers looped their health information management (HIM) teams into the process early, as they should whenever new health IT applications are implemented.

Lori L. Richter, MA, RHIA, CPHIMS, CHPS, system director for health IT regulatory oversight and corporate responsibility at CommonSpirit Health, who played a key role in her organization’s telehealth vendor selection process, says HIM’s involvement—at every stage of the implementation—was key to the project’s success.

“Telehealth or virtual care is something that we need to make very clear that HIM should be involved in, to make sure practitioners don’t forget that we’re still capturing information for the legal medical record,” Richter says.

She notes that providers might use Zoom’s audio and video capabilities while documenting in a traditional electronic health record (EHR), or they may opt for a more integrated solution that allows them to document and provide an audio or video consult in the same place.

“The question the organization needs to ask is, are we maintaining a hybrid electronic medical record with patients in two different EHRs [EMRs] or do we somehow send a subset to the chart? That’s another place HIM should be thought of when we’re thinking of these platforms,” Richter says.

HIM professionals also had to walk stakeholders through the federal government’s telehealth waiver programs, the process of obtaining verbal or written consent from patients, navigating various payer billing requirements, workflows, release of information, coding, and public-health reporting requirements for COVID-19. Without HIM’s input and collaboration, the organization could have been stuck with lagging revenue, noncompliant or incomplete documentation, overlooked cybersecurity vulnerabilities, or financial penalties for HIPAA violations.

Richter says that her team’s involvement in telehealth vendor selection was typical of other health IT implementations in her organization. However, in many other places, involving HIM is an afterthought if they’re considered at all, a possible factor in high rates of high health IT implementation failures.

Crash and Burn

According to a 2017 study published in the journal Procedia Computer Science, healthcare technology projects fail 70 percent of the time. A report from the Fox Group estimates that at least 20 percent of EHR implementations, usually the most consequential technology investment in most health organizations, fail due to software incompatibility, technical implementation failures, lack of a return on investment, and other people-related issues.

At industry trade shows, new devices, software applications, and enterprise systems are aggressively marketed as cure-alls for nearly every clinical or revenue cycle challenge facing a hospital or care unit. However, in too many instances, the actual results bear little resemblance to what was promised in the exhibit hall.

It’s not that the solutions are necessarily bad, but without input from the proper stakeholders, they can potentially cause more problems than they solve.

Seth Hirsch, chief operating officer for Systems Engineering Solutions, has seen this happen firsthand.

“You go to these conferences and you see these whiz-bang new toys and it looks fantastic. And then you get it and you realize, one, you’re not able to utilize it the way you thought. Or, two, you don’t really know how to utilize it,” Hirsch says. “And you’re kind of left with, ‘All right, well, what do I do now? I just spent all this money on this thing. All it’s really doing is causing me more problems because I can’t use it and I’m spending a lot of money on it.’”

If HIM is involved in an IT implementation from the start a lot of these issues can be prevented. The ideal scenario for a health IT implementation, according to Richter and Hirsch, is one in which HIM: has a role in every phase of deployment; uses assessments and frameworks to evaluate a product; has a role in determining clinical workflows; and assists providers to mitigate burnout.

Fighting Old Perceptions

Though HIM professionals long ago proved their worth on the business side of healthcare, many of them are still actively fighting the perception that they are medical librarians a couple steps removed from technology.

Bob Gronberg, senior director of Meditech professional services at CereCore, an HCA subsidiary, says HIM is wrongly undervalued in some organizations—though that is changing in this post-Meaningful Use era.

“HIM professionals provide an awful lot of value in these big implementation processes that are responsible for the [patient] record,” Gronberg says. “They’re the ones making sure it’s [the record] complete and cohesive, that it’s a tool that can be used by the clinician and others to retrieve information for normal operations, making sure the information isn’t duplicate, captured where it should be captured, that it’s transferred and transmitted and reused as appropriate.”

Dale Kivi, MBA, senior director of communications for Aquity Solutions, has worked in the clinical documentation space for more than 25 years, and in that time he’s seen how HIM’s role has evolved with the emergence of EHRs and other electronic health IT systems.

In his experience, HIM professionals, historically, were the ones responsible for buying decisions for new technology and services, but this started to change as certification requirements were implemented after Meaningful Use. That change shifted decision making to the IT department, causing HIM to get left out of discussions.

Asking Uncomfortable Questions

The difference between what works well in theory and what works in real life can create a conflict among stakeholders, Kivi says.

One example of this is an experience of friends of his that worked at a large healthcare system in South Carolina during a major EHR implementation project.

“After the first three meetings to try and implement the EHR, HIM was disinvited from the meetings, because [other members of the project team would] talk about something and the HIM director would raise her hand and say, ‘That’s not going to work, and let me tell you why.’ And so she got disinvited from the meetings,” Kivi says. “Then, when they launched [the EHR] and the wheels fell off, HIM was the one required to fix it. It is, I believe, the role and responsibility of HIM to elevate their presence within the healthcare organization by being the interpreter between the reality of day-to-day practice.”

In the scenario Kivi describes, the HIM professionals were doing precisely what they were trained to do. Jill Clark, MBA, RHIA, CHDA, FAHIMA, senior consultant and knowledge office for e4 Services, says it’s HIM’s job to ask the questions others are not, particularly questions pertaining to workflow and information output.

The HIM skillset set—including knowledge of terminology and classification systems, data integrity, data analysis and data management—proves beneficial when designing or modifying workflows and queues and discussing system integration.

“Asking questions of the project team to confirm the use and output of the data collected allows opportunity for early collaboration with clinical documentation integrity, can help mitigate billing edits, and support data integrity specific to duplicate data creation and master patient index (MPI) management,” Clark says.

“You go to these conferences and you see these whiz-bang new toys and it looks fantastic. And then you get it and you realize, one, you’re not able to utilize it the way you thought. Or, two, you don’t really know how to utilize it,” Hirsch says. “And you’re kind of left with, ‘All right, well, what do I do now? I just spent all this money on this thing. All it’s really doing is causing me more problems because I can’t use it and I’m spending a lot of money on it.’”

Whether they’re selling an EHR, a clinical documentation integrity solution, or  revenue cycle software, every health IT vendor knows that the road to a successful and sustained go-live runs through the HIM department.

“[HIM teams] should be looked at as really stakeholders in this whole thing, because they are,” says Hirsch. “You want their buy-in. You want to make sure upfront when you’re defining all the requirements or understanding all the requirements, that they’re in those meetings to clarify and make sure that everyone’s on the same page as to the scope. When you’re doing your demos you should make sure they’re nodding their head as if to say ‘Yeah, this is meeting the need.’ And if they’re not, then you have that instant feedback right there.”

As the World Turns

Because HIM’s expertise spans the evolution of every healthcare encounter, from intake and admission to payment of claims and denial management, their participation all the way through an implementation process can help prevent any “gotcha” moments throughout a project’s lifecycle, says e4’s Clark.

She says HIM’s responsibilities increase during an implementation since it is advantageous to get their input in workflow design discussions as well as validation and testing.

“Education is also key during implementation to ensure areas such as transcription/voice recognition, medical coding, and document imaging are included in the education planning discussions. HIM team involvement continues during cutover and transition to live for support. Examples include but are not limited to conversions of patient identification for current bed assignments, master patient index management and data integrity reporting, scanning operations of current paper records (where applicable), review of billing edits and similar revenue integrity reporting,” Clark says.

During a project’s go-live, making sure an HIM professional is stationed in the “command center” is imperative, according to people who have been involved in many rollouts.

Whether they’re selling an EHR, a clinical documentation integrity solution, or  revenue cycle software, every health IT vendor knows that the road to a successful and sustained go-live runs through the HIM department.

Gronberg, who says he’s been accused of being a masochist over his excitement for project go-lives, says forward-thinking project managers put HIM representatives in the center of the action.

“They have an ability to quickly fix problems and change things and address issues that maybe didn’t come up in testing, training, or other part of a project. Tend to come up at go-live. They’re thinking about the long term and what this looks like—downstream systems, downstream departments, how best to work through this,” Gronberg says.

He notes that the focus on the endgame that HIM professionals bring to the table isn’t especially intuitive to others involved in the process. But Gronberg also doesn’t see as many HIM professionals as involved in physician training as he would like to see, especially since HIM is attuned to the pinch points and have vast knowledge about how documentation systems work.

“The HIM pros are the ones that can say ‘Yeah, that guy over there, that physician is tough, these people over here are no problem.’ They know that about these people because they work with them daily. So just having some of that, being able to plan around that is important,” Gronberg adds.

Including HIM professionals at all phases of an implementation can help reduce physician burnout with EHRs as well, since HIM can identify opportunities to minimize or condense workflow, prevent duplicate data entry, offer opportunities for integrated solutions that provide efficiency and excellence to customers—including providers, system users, and patients alike, Clark says.

Syndicated from https://journal.ahima.org/fail-safe-him-experts-are-essential-early-in-the-it-adoption-cycle/

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