HIM 440 Milestone One Guidelines and Rubric
Overview: For a healthcare organization to be effective in meeting information management needs, the Health Information Management (HIM) department
must operate with a clear vision and purpose and be able to forecast needs across the continuum of care and healthcare enterprise. It is essential for the HIM
department to run efficiently and effectively while maintaining the highest levels of quality and quantity set forth by preestablished standards and
measurements. Health information managers are also charged with overseeing the training and development of staff to ensure compliance with rules,
regulations, and organizational needs.
This milestone covers the first section of the final project: Initiation and Preparation Phase. It provides you with an opportunity to receive early feedback from
your instructor that you will incorporate into your final submission.
Prompt: Review the Gateway Healthcare Systems case study and analyze the state of the unified health information management department of Gateway
Healthcare Systems during the initiation of the merger. Identify the current position of the department to inform the key initiatives of the improvement plan.
Specifically, the following critical elements must be addressed:
I.
Initiation and Preparation Phase: In this section, you will review the case study. You will analyze the current state of the health information
management department during the initiation of the merger. You will identify the current position of the department to inform the key initiatives of the
improvement plan. You will include the following elements:
A. Using the details provided in the case study, summarize the issues for the health information management department during the merger.
B. From a compliance standpoint, determine current challenges the health information management department is experiencing.
C. Explain the impact of cultural diversity on the productivity and quality of the health information management department.
D. Analyze the mission and vision of the organizations in the merger to inform and create a unified mission and vision for the health information
management department.
E. Using the provided SWOT matrix template, identify the strengths, weaknesses, opportunities, and threats facing the health information
management department as a result of the merger.
Rubric
Guidelines for Submission: Your Milestone One paper should be a 3- to 4-page Microsoft Word document, excluding the title and reference pages, with double
spacing, 12-point Times New Roman font, one-inch margins, and sources cited in APA format. The SWOT analysis should be submitted using the provided SWOT
matrix template.
Critical Elements
Initiation and
Preparation
Phase: Summarize
Proficient (100%)
Summarizes the issues of the health
information management department
during the merger based on the details
provided in the case study
Initiation and
Preparation
Phase: Compliance
Determines challenges the health
information management department is
experiencing from a compliance
standpoint
Explains the impact of cultural diversity
on the productivity and quality of the
health information management
department
Initiation and
Preparation
Phase: Cultural
Diversity
Initiation and
Preparation
Phase: Mission
and Vision
Analyzes the mission and vision of each
organization involved in the merger to
inform the mission and vision statement
for the health information management
department
Initiation and
Preparation
Phase: SWOT
Identifies the strengths, weaknesses,
opportunities, and threats facing the
health information management
department using provided SWOT matrix
template
Articulation of
Response
Submission has no major errors related
to citations, grammar, spelling, syntax,
or organization
Needs Improvement (75%)
Summarizes the issues of the health
information management department during
the merger based on the details provided in
the case study, but response contains
inaccuracies
Determines challenges the health information
management department is experiencing from
a compliance standpoint, but response is
cursory or contains inaccuracies
Explains the impact of cultural diversity on the
productivity and quality of the health
information management department, but
response is cursory or illogical or lacks
justification
Analyzes the mission and vision of each
organization involved in the merger to inform
the mission and vision statement for the health
information management department, but
analysis is cursory or illogical or does not
contain information about all three
organizations
Identifies the strengths, weaknesses,
opportunities, and threats facing the health
information management department using a
SWOT matrix, but response contains
inaccuracies, is incomplete, or is not contained
in the provided SWOT matrix template
Submission has major errors related to
citations, grammar, spelling, syntax, or
organization that negatively impact readability
and articulation of main ideas
Not Evident (0%)
Does not summarize the issues of the
health information management
department using the provided case
study
Value
18
Does not determine challenges the
health information management
department is experiencing from a
compliance standpoint
Does not explain the impact of
cultural diversity on the productivity
and quality of the health information
management department
18
Does not analyze the mission and
vision of each organization in the
merger
18
Does not identify the strengths,
weaknesses, opportunities, and
threats facing the health information
management department using the
provided SWOT matrix template
18
Submission has critical errors related
to citations, grammar, spelling,
syntax, or organization that prevent
understanding of ideas
Total
10
18
100%
Running head: TITLE OF PAPER IN CAPS Page #
Instructions:
Please format paper per APA guidelines: Include the title page requirements, the
headings/subheadings already provided for you, an introduction, the body of your paper using
the headings/subheadings provided, a conclusion paragraph, a references page, and in-text
citations to match the references. Please be sure to remove all of these instructional notes before
submitting your finished paper.
Title of Paper
Your Name
University’s Name
TITLE OF PAPER IN CAPS
Page #
Title of Paper (Centered and not bolded)
Initiation and Preparation
In this section, you will write a brief introduction.
Summary
This section coincides with the first critical element on the rubric. You will summarize the
issues in the HIM department related to the merger.
Compliance
This section coincides with the second critical element on the rubric. You will address the
compliance issues noted in the case study in this section.
Cultural Diversity
This section coincides with the third critical element on the rubric. You will address the
cultural issues impacting quality and productivity.
Mission and Vision
This section coincides with the fourth critical element on the rubric. You will analyze the
mission and vision of each hospital.
SWOT Analysis
This section coincides with the fifth critical element on the rubric. You will analyze the
strengths, weaknesses, opportunities, and threats facing the HIM department. You will complete
the SWOT analysis matrix AND include a brief summary of your findings in this section.
This section coincides with the third critical element on the rubric. You will explain the new
standard process for delivering feedback to staff based on their performance appraisal using
management strategies.
Conclusion
TITLE OF PAPER IN CAPS
Page #
In this section, write a brief summary of your findings above. Be sure to include
references and the corresponding in-text citations. A reference page is located following this
page.
TITLE OF PAPER IN CAPS
Page #
References
HIM 440 Gateway Healthcare Systems Case Study
St. Catherine’s Medical Center recently announced it will be merging with St. Luke’s Hospital
and Hickman Community Hospital to form Gateway Healthcare Systems, all located within the
same metropolitan area in the Midwest. You have just been hired as the healthcare system’s
HIM director overseeing all three hospitals. Each facility’s department manager or supervisor
will report to you.
Hospital Profiles
St Catherine’s Medical Center
HIM Department Mission: Grounded in the Catholic mission of service, we strive to provide
accurate patient health information services to all patients with care, concern, and dignity.
HIM Department Vision: Provide patients with their health information with sensitivity and
respect to their privacy.
Profile: St. Catherine’s is affiliated with the Catholic faith and includes an active convent on its
campus. It is an 850-bed acute care level-one trauma facility located in the suburbs. The staff
and patients come from a variety of ethnic backgrounds and are linguistically diverse. About
60% of St. Catherine’s staff is Catholic, but the hospital abides by legal hiring practices and
insists that all employees are treated with respect, including those who fall outside the tenets
of Catholicism. In fact, the HIM department has two staff members with hearing impairment
who work in the coding section. They have been investigating ways to offer more opportunities
to potential employees with physical needs, but with the high volume of reading and direct
customer service provided to patients, it has been difficult to accommodate.
St. Catherine’s has a reputation of providing quality care to all patients and will not turn away a
patient based on ability to pay. It is located in one of the wealthier suburbs of the city and has a
strong record of employment retention, even though the average salary level is lower than
those of its competitors. St. Catherine’s implemented a new EHR last year and continues to
work out new policies and procedures for the new system. Its dictation system was
implemented seven years ago. The productivity level has been critically low since implementing
the new system.
Due to recent budget cuts, St. Catherine’s cannot offer overtime to staff. The HIM department
has many long-term employees that do not have formal health information education or
credentials. The current coding productivity level is, on average, two inpatient charts per hour
per coder, and 10 outpatients (including ED patients) per hour per coder. The coding quality
consistently exceeds 95%, per the internal coding auditor.
Coding productivity standards were established six years ago using ICD-9 standards, at four
inpatient charts per hour. The productivity standards remain at four inpatient charts per hour,
despite complaints from coders that the standards are unreasonable.
St. Catherine’s last TJC site visit was in October of last year. Overall, the hospital fared well on
inspection; however, the HIM department was cited for not having a time stamp on orders in
the EHR. (For more information, review regulations RC.01.01.01, EP19 in The Joint Commission
E-dition Manual).
There have been complaints in the department that some staff do not abide by the break
schedule, and some take longer lunches than allowed. Management has not addressed this
with staff for fear of losing some of their most knowledgeable and credentialed staff. It has
been reported that some of the seasoned coders who have been on staff for more than 25
years are still using the manual coding book rather than the encoder that was implemented five
years ago, stating that this saves them valuable time; however, the more recently hired coders
are using the encoder system.
St Luke’s Hospital
HIM Department Mission: To provide providers, residents, and staff with timely access to
patient health information for purposes of treatment, research, and reimbursement.
HIM Department Vision: Promoting research through state-of-the-art health information
management and technology.
Profile: St. Luke’s, established in 1942 as a Methodist hospital but no longer a faith-based
facility, is a very busy, 400-bed inner-city teaching hospital that provides critical care services to
many patients without healthcare coverage. It services the most diverse patient population in
the city in terms of ethnicity, religion, class, ability, sexuality, and age; however, its staff
diversity is low except in the area of age diversity. The youngest employee is 19 years old and
the oldest is 72.
St. Luke’s has experienced a high volume of staff turnover during the past three years and does
not currently have a HIM manager or director on staff. While it does have credentialed HIM
staff, it has difficulty keeping them on board for more than two years.
St. Luke’s is using a first-generation EHR that was implemented seven years ago and has
difficulty communicating with the other systems in the department and organization. Because
of the issues with interoperability, the lab sends down daily batches of paper lab reports that
are scanned into the EHR. The encoder was just implemented last year; however, only one
coder was thoroughly trained on the new encoder, and she resigned over a year ago. Coding
staff frequently use the manual coding books because they cannot seem to find the accurate
codes with the encoder. They spend a great deal of time looking up codes in the coding book,
then going to the paper binders with the coding clinics to ensure that they are assigning the
correct codes. Coding productivity standards were revised after the implementation of ICD-10.
Current productivity standards are set at two inpatient charts per hour.
The coding supervisor is a new graduate with less than a year of inpatient coding experience.
She does not get along well with her subordinates, who are older and have much more
experience. Coding productivity is being met per the performance expectations established ten
years ago; however, coding quality is consistently rated at 85%, per the external auditing firm.
Hickman Community Hospital
HIM Department Mission: To assure protection of patient health information at all times.
HIM Department Vision: Committed to serving the local community’s health information needs
and ensuring patient information is secure.
Profile: Hickman is a non-faith-based, 90-bed community hospital located in the oldest part of
the city. It has historically served a predominantly low-income, Caucasian patient population,
which is comprised mostly of Medicare and Medicaid payers. It has recently been seeing a rise
in Muslim patients due to a new mosque in the neighborhood. Hickman Community Hospital
has provided services to its local community since 1922, and it is the oldest facility of the three
merging organizations.
This facility has accessibility issues and was deemed noncompliant with ADA guidelines during
the last Joint Commission accreditation survey. Since the hospital staff and patient population
are primarily of one ethnicity, the hospital has not seen the need to address cultural diversity
training, and therefore it was found noncompliant with TJC standards on leadership.
The employees of Hickman are like family—they stick together. While Hickman is the lowestpaying hospital in the area, the family culture has contributed to the longevity of its staff.
The HIM department does not currently have any AHIMA-credentialed staff members and does
not have any coding quality or quantity expectations in place for the part-time staff members
responsible for coding the charts. Hickman is still using paper-based records and manual coding
books and resources for coding and billing resources. Hickman currently has a ten-day
turnaround time from discharge to final bill dropped, and there is currently no specified
number of charts that should be completed on an hourly or daily basis by coders.
The acting HIM manager has been employed by Hickman for 35 years and is very fond of her
staff; she insists they do the best job in town. Her job as acting HIM manager was meant to be
temporary while Hickman searched for a credentialed replacement. The one candidate who
met all qualifications was determined “not a good fit” by the hiring committee. He was a 32-
year-old African American male and a wheelchair user. Currently, the HIM department does not
have any diversity in ethnicity or physical ability among staff members.
Preliminary Observations
During the first month in your new position as HIM director of Gateway Healthcare Systems,
you spent a week at each hospital getting to know staff, reviewing policies and procedures, and
making general observations.
While visiting with staff at St. Catherine’s, you noticed a few staff members were discarding
paper forms with patient-identifying information into the trash can underneath their desks,
instead of disposing of the forms in the document shredder located in the front office. You also
noticed that the “release of information” staff did not log out of their computers when they
were away from their desks.
At St. Luke’s, you overheard a discussion in the main lobby elevator between two nurses
discussing patient Mary Smith’s prognosis. When you arrived in the HIM department, there
were stacks of paper forms and old paper records scattered throughout the department with
the patient information openly displayed. In the connecting hallway that patients frequently
travel through, you found several carts of records that revealed patient-identifying information.
At Hickman Hospital, you arrived to find the staff sitting around having coffee while several
patients were waiting to be assisted with obtaining copies of their health records. The releaseof-information clerk came running into the office with a paper copy of a record to hand to one
of the patients in line, and said, “Here you go, Mrs. Brown; here’s the copy of your record from
Dr. Taylor’s office. He’s our best psychiatrist on staff! You’re in good hands!” Once all of the
patients had been waited on, the staff began discussing each patient’s requests along with their
diagnoses, medical treatment, and prognosis. At this point, you called an urgent staff meeting.
Current Facility Staffing
Name of
Facility
Number of
FTEs/PTEs
St. Catherine’s
St. Luke’s
Hickman
55 FTEs/15 PTEs
40 FTEs/5 PTEs
3 FTEs/10 PTEs
Number of
Management
Staff
5
10
1
Number of
Credentialed
Coders
4
10
0
Number of
Transcriptionists
6
8
2
Number
of
ROI Staff
6
1
0
National Performance Measurement Standards
ICD-10 Coding Productivity Study Highlights Emerging Standards
New Study Illuminates the Ongoing Road to ICD-10 Productivity and Optimization
Number of
Support Staff
FT/PT
49
16
10
Top Five Diagnoses by Hospital
St. Catherine’s
Diagnoses
Average Length of Stay
(ALOS)
Average Time to Code
in Minutes
Chronic Obstructive
Pulmonary Disease
(COPD) with Major
Complication/
Comorbidity (MCC)
10
39
Gastrointestinal (GI)
Hemorrhage with
Comorbid Condition
(CC)
11
45
Pulmonary Edema and
Respiratory Failure
9
43
Septicemia or Severe
Sepsis without
Mechanical Ventilation
(MV), 96+ Hours with
MCC
17
53
Spinal Stenosis, Lumbar
Region with Combined
Anterior/Posterior
Spinal Fusion with MCC
12
130
St. Luke’s
Diagnoses
ALOS
Average Time to Code
in Minutes
Intracranial
Hemorrhage or
Cerebral Infarction with
Comorbid Condition
(CC) or Tissue
Plasminogen Activator
(tPA) in 24 hours
6
38
Renal Failure with MCC
8
42
Spinal Stenosis, Lumbar
Region with Combined
Anterior/Posterior
Spinal Fusion with MCC
10
121
Sepsis, Unspecified
18
Organism,
Tracheostomy with MV
> 96 hours or Principal
Diagnosis Excludes (PDX
EXC) Face, Mouth &
Neck without Major
O.R.
65
Septicemia or Severe
Sepsis without
Mechanical Ventilation
(MV), 96+ Hours with
MCC
43
13
Hickman
Diagnoses
ALOS
Average Time to Code
in Minutes
COPD with MCC
8
46
Heart Failure and Shock
with MCC
10
55
Normal Newborn
1.5
30
Renal Failure with MCC
10
62
Vaginal Delivery w/o
Complicating
Diagnoses
2
45
SWOT Analysis
Strengths
The members of staff are diverse in both culture and language.
Staff members are treated fairly regardless of any physical impairment.
High rate of staff retention.
Highly rated on coding productivity standards by external auditors.
A qualified coding supervisor on staff.
Weaknesses
EHR productivity is low.
Lack of confidentiality of patient information.
Lack of cultural diversity among staff.
EHR systems not integrated with other department.
Low staff pay.
Opportunities
Meeting ICD standards of encoding four patients per hour.
Use of encoder systems.
Presence of multiple facilities.
‘Use of modern technology.
Threats
Serving low-income patients who have limited funds.
Patients receiving service on credit could result in limited source of funds.
Employee turnover due to mismanagement.
SMART Goals
Cultural Diversity
Attract and retain qualified employees from different cultural backgrounds.
Human Resources
Provide employees with continuous internal and external training in their particular job
classifications.
Compliance
By January 2019, the Unified Gateway Healthcare Systems will comply with all legal and
standardization requirements.
SWOT Analysis
Strengths
The members of staff are diverse in both culture and language.
Staff members are treated fairly regardless of any physical impairment.
High rate of staff retention.
Highly rated on coding productivity standards by external auditors.
A qualified coding supervisor on staff.
Weaknesses
EHR productivity is low.
Lack of confidentiality of patient information.
Lack of cultural diversity among staff.
EHR systems not integrated with other department.
Low staff pay.
Opportunities
Meeting ICD standards of encoding four patients per hour.
Use of encoder systems.
Presence of multiple facilities.
‘Use of modern technology.
Threats
Serving low-income patients who have limited funds.
Patients receiving service on credit could result in limited source of funds.
Employee turnover due to mismanagement.
SMART Goals
Cultural Diversity
Attract and retain qualified employees from different cultural backgrounds.
Human Resources
Provide employees with continuous internal and external training in their particular job
classifications.
Compliance
By January 2019, the Unified Gateway Healthcare Systems will comply with all legal and
standardization requirements.
1
Running Head: Gateway Health System
Gateway Health System
Olawunmi Odusanya
HIM-350
Professor Dana Brenda
November 11, 2018
2
The mission and vision statements of the three hospitals are tailored towards showing how
they strive to provide accurate information for use by the patient. They all carry out their operations
without discriminating based on the patients’ background of gender, age, religion or ethnicity. All
of the hospitals consider health as a sensitive issue which means that the three hospitals are doing
well in providing universal health information management. This is crucial for providing both
accurate diagnosis and treatment for patients. Accurate information is a common outcome from
the health information systems department of the three hospitals. In addition, these hospitals also
seek to provide their patients with accurate information.
Saint Catherine’s Hospital and Saint Luke’s Hospital’s mission and vision statements do
not have information pertaining to security or timeliness included. While St. Luke’s Hospital talks
about timely access to information, there is no mention of secure information. It is important that
both of these factors be included in the mission and vision statements for the Unified Gateway
Healthcare System. Saint Catherine’s Hospital is the only one of the three hospitals that has a
religious base, which is based on the Catholic mission of service. Hickman Hospital does not
include much information pertaining to the patient’s protection. From the vision and mission
statement of Hickman Hospital, there is not much information regarding how the hospital plans to
protect patient information.
Saint Catherine’s Hospital is sensitive to customers’ needs as
indicated by the statement of concern, care and privacy in their vision and mission statements,
unlike the statements of the two other hospitals.
2
Unified Gateway Health System Mission Statement: We strive to provide our patients,
providers, and staff with accurate, timely, and secure health information, based on care, concern,
and dignity, at all times.
Unified Gateway Health System Mission Vision Statement: Committed to serving our patients
and the local community with secure health information that is sensitive and respectful, by
promoting research and using state-of-the-art health information management and technology.
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