In the June print issue Robert James Campbell writes on applying lean thinking techniques to healthcare. The process improvement technique can be used to identify and eliminate waste in any activity. Campbell, an assistant professor at East Carolina University in Greenville, NC, teaches the lean thinking technique to health services and health information students. Here he shares one project in which students reengineer a patient transfer process using lean thinking.

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As healthcare expenses continue to erode household, government, and provider budgets, the industry needs better methods to reduce the cost of care. One tool that can increase efficiency and value is a change management technique called lean thinking.

Lean thinking is based on the Toyota Production Model and is built upon five steps to identify and eliminate waste: value, value stream, flow, pull, and perfection. The ultimate goal of lean thinking as applied to healthcare is to provide services and products that add value to the patient by improving care in the most efficient manner possible. (more…)

New Health and Human Services secretary Kathleen Sebelius was on Capitol Hill yesterday with two new reports from the Agency for Healthcare Research and Quality in hand. Both had discouraging news about the quality of healthcare Americans received in 2008.

In particular, Sebelius singled out unequal care. AHRQ’s “2008 National Healthcare Disparities Report,” she told the House Ways and Means Committee, “highlights that severe and pervasive disparities continue to persist in this county. Minority patients still receive disproportionately poor care compared to their Caucasian neighbor.”

Solving healthcare disparities is complicated by a lack of comprehensive data about its prevalence.

Last month in the Journal, Jennifer Hornung Garvin and coauthors wrote, “At the heart of … efforts to develop effective strategies to address healthcare disparities is the need for accurate and complete data. However, data describing racial, ethnic, language, cultural, and socioeconomic characteristics are frequently inaccurate, incomplete, and lacking in detail in the healthcare setting. Sometimes they are not collected at all.”

Addressing healthcare disparities, the authors stress, “requires that providers capture better data about race, ethnicity, and socioeconomic status, an effort complicated by the sensitive nature of the data and the challenges of categorizing them appropriately.” They point to several data sets that providers can adopt to improve their collection of this so-called equity data in support of efforts to create equal care for all.

See “Data Collection and Reporting for Healthcare Disparities” in the April 2008 issue.

Healthcare organizations must ensure that their sanctions policies for internal privacy and security breaches are consistent, fair, and objective for all staff members. Organizations that fail to do so send a confusing message to staff, compromise their privacy and security programs, and lose public trust.

The May practice brief “Sanction Guidelines for Privacy and Security Breaches” offers recommendations for the internal application of sanctions related to information privacy and security breaches for healthcare organizations that manage or service protected health information or individually identifiable health information.

The brief includes a sample sanctions determination document that organizations can customize for their investigations and trending. Each incident requires appropriate investigation along with managerial discretion to declare a misdeed.

“No two healthcare organizations will approach sanctioning and enforcement for privacy and security breaches in exactly the same way,” the authors write. “Each healthcare organization needs to show a demonstrated, consistent ability to deal with privacy and security issues in its own way to ensure consumer trust. Inherent to privacy and security professional roles is a firm leadership commitment to consistent policy and enforcement and sanction application for noncompliance.”

The Department of Health and Human Services has published guidance related to the Genetic Information Nondiscrimination Act (GINA) and its effect on researchers.

“Guidance on the Genetic Information Nondiscrimination Act: Implications for Investigators and Institutional Review Boards” provides background on protections provided by GINA and discusses GINA’s impact on investigators who conduct genetic research and the institutional review boards that review it, particularly on criteria for IRB approval of research and the requirements for obtaining informed consent under the HHS regulations for the protection of human subjects (45 CFR part 46).

Final GINA regulations are expected in May.

To review GINA’s provisions, see the July 2008 “Word from Washington” column “Getting to Know GINA.”

In the March print story “Virtual HIM,” Cheryl Servais, MPH, RHIA, discusses the organizational issues in transitioning HIM departments to remote, virtual departments. Servais notes that virtual departments offer organizations operational, financial, and staffing advantages, as well as opportunities to increase levels of service.

Within that article, Deborah Kohn offers a matrix of HIM functions that can be performed remotely and the line-of-business information systems that support them. Kohn, MPH, RHIA, FACHE, CPHIMS, expands that topic in a full web-only feature story.

“Redisclosure of Patient Health Information (Updated),” the practice brief in this month’s print issue, offers guidance on one of HIM’s trickier issues. Redisclosure is the sharing or release of patient health information that the organization received from another source (such as a facility or provider) and subsequently made part of the patient’s health record or the organization’s designated record set. A glance at the sample situations in the brief shows just how complicated this issue can become.

AHIMA’s library contains additional related guidance on redisclosure. Look for these practice briefs:

• “Defining and Disclosing the Designated Record Set and the Legal Health Record”
• “Notice of Privacy Practices”
• “Patient Access and Amendment to Health Records (Updated)”
• “Understanding the Minimum Necessary Standard (Updated)”

For organizations that allow clinicians to carry forward clinical documentation in electronic records, auditing its proper use is key to ensuring document integrity. Copying clinical documentation poses both clinical and compliance risk. The feature “Auditing Copy and Paste” offers guidance in creating a solid audit plan.

The story is adapted from the broader AHIMA resource “Copy Functionality Tool Kit.” It offers sample policies, testing activities, case scenarios, and questions organizations can ask when considering the use of copy and paste.

You’ll find a lot of other good practice resources on that page.

The January practice brief recommends resources for regulations and standards that apply to HIM practice in a range of settings. See the online version for links directly to the sources.

Get hip with HIPAA.

That’s just one of the taglines attached to Sharp Healthcare’s HIPAA education modules. Photos from the age of hip—the late 1960s and early 1970s—permeate the online HIPAA training modules. Musicians Jimi Hendrix and Bob Dylan and era-TV icons like the Get Smart cast mingle with privacy requirements and confidentiality factoids.

The hip-themed training is just one theme in a series of HIPAA privacy, security, and confidentiality training modules at the San Diego-based facility.

The incorporation of a new theme each year assures that Sharp’s staff of 12,000 employees learn more than how to fall asleep during training, says Paul Belton, RHIA, Sharp’s vice president of corporate compliance and creator of the unique training programs.

“All this is to just try and keep this fresh,” Belton says. “You come up with something that would be tasteful and flavorful to them to [avoid] the dry and boring education modules that are so typical.”

Keeping a facility’s HIPAA education program interesting year after year can be a challenge for privacy officers. They must develop interesting, comprehensive programs that stick for new employees as well as fresh refresher programs for current staff. (more…)

The clarifications continue over CMS’s approach to signature stamps. This past July CMS issued a clarification that stamps were not permissable on any medical record. Now a new clarification advises that some payers do not accept stamps but the Conditions of Participation do not prohibit them.

In the latest memorandum, dated October 24, CMS writes that the Conditions of Participation:

“do not prohibit the use of rubber stamps in a hospital setting, when properly controlled, for authentication of medical record entries. However, as a point of information for surveyors and providers, we are taking this opportunity to add an information-only statement to the interpretive guidance for §482.24(c)(1) to note that some payers, including Medicare, may not accept such stamps as sufficient documentation to support a claim for payment.”