How To Assess Your Team and Processes During Changes in Technology

From community access hospitals to large, national health systems, many healthcare organizations plan to replace, consolidate, or upgrade their electronic health records (EHRs) systems this year.  

Health information (HI) leaders often take this opportunity to assess every step of their department workflows including areas like release of information (ROI), coding, and denial management. Working with other department leaders, they can review entire processes from start to finish. The goal is to define the current state and the optimal state, compare them to best practices, and close any gaps. 

These assessments provide directors with a roadmap for success and a list of clear action items. This ensures major EHR changes help the health system achieve its long-term goals: advancing organizational efficiency and improving patient care. 

However, EHR change events aren't the only time to consider an HI assessment. They're also extremely beneficial for newly hired HI directors who need to understand their department's strengths and weaknesses, or for long-term leaders who want to resolve areas of concern. 

Here is practical advice for HI leaders preparing to conduct a department assessment.  

Three Reasons to Do an HI Assessment 

The most common reason to perform an assessment is to prepare departments for a major EHR change. These often occur during the acquisition of a new hospital, a system conversion, or a major upgrade. An assessment gives directors the opportunity to take an objective view of people, processes, and technology that will be impacted by the change. 

New directors benefit from this assessment because they often don’t have the time or bandwidth to take a deep dive into every aspect of department operations and workflows. A review provides insights for new directors to quickly know which areas need improvements in people, processes, or technology.  

Focused assessments are considered a best practice when HI leaders want to focus on a single process or problem area. This could include such issues as too much paper in off-site storage, higher-than-expected outsourced coding costs, or the inability to determine the root cause of a specific denial type. They often have a hunch about operational inefficiencies or cost issues, but an assessment turns that intuition into specific and actionable improvements.  

Listen, Walk through the Process, and Document 

The first step of an assessment involves listening to stakeholders to understand where the department believes problems lie. Most organizations already have an idea of their issues and the end goal they want to achieve. 

Using LEAN methodology, on-site listening sessions are held with organization leaders from HI, IT, revenue cycle, and any other impacted department to share where challenges are occurring. It's also important to include at least one staff member or subject matter expert (SME) who performs day-to-day functions such as ROI, coding, record completion and delinquency reporting, denial management, and audits. 

From there, assessment project leaders will walk through each process step-by-step with the SME to document the current state of each workflow. This may include observing and documenting the following:

• Each person and step involved in the process 
• Every system involved and each keystroke taken 
• All systems accessed 
• All data entered and information required 
• Outcomes and reports produced 

IT analysts add value to these assessments as they understand the nuances and limitations of each existing system, the technological integration points involved, and the future capabilities of a new system. Assessment teams will also conduct a thorough evaluation of all reports currently produced. 

The length of the assessment will depend on the project. For example, evaluating the revenue cycle from prior authorization to denial management could take four to six weeks. More targeted assessments, such as the ROI process or the document scanning function, may only require two to three weeks. 

Define Gaps and Compare Best Practices 

With the current state of each HI process defined, the next step is to lay out the optimal future state and identify gaps in people, processes, or technology. A side-by-side comparison of the current state with industry best practices is helpful at this phase. This comparison will quickly demonstrate gaps between the current and optimal states. In most cases, technology gaps will be automatically remedied by the new system. 

There is a difference between an “ideal” state and an “optimal” state. Assessment participants will often describe an ideal state as where they receive every new capability on their wish list. HI leaders should work to establish realistic expectations and redirect team goals toward an optimal state. Redefining performance metrics is another important step. By understanding which metrics are monitored and how they are measured, leaders can set new targets.  

Build Roadmap and Action Lists 

The final step in the HI assessment is to create a roadmap with specific action items, which should be divided into 30-, 60-, and 90-day lists and assigned color codes for low, medium, and high priority. 

Using medical record completion and physician delinquency problems as an example, here are the associated action lists and items for each that may be developed and assigned:  

Ongoing monitoring post implementation is also necessary to ensure gaps are closed and the optimal state is achieved. 

Redefining the Legal Health Record 

One of the most significant gaps for any organization preparing for a new IT system is formalizing its definition of the legal health record. Many organizations struggle with this task as IT systems are added or removed over time through mergers, acquisitions, and system attrition. 

Knowing the location of all medical record information and how long it needs to be retained is a critical step in implementing a new EHR. Data validation and migration cannot begin until the location of all health information is known. 

Assessment teams also should take a deep dive into each piece of the designated record set. A best practice is to examine each system, its interfaces, the location of both digital and paper information, how the information is used, and its retention periods. For organizations that serve multiple states, it’s necessary to comply with the longest retention period for the legal health record's definition.  

The following questions are good starting points for HI leaders to begin this journey, define the legal health record, and set a policy for the designated record set moving forward: 

• What does a ROI specialist provide to someone who asks for an entire medical record? Where do they go to access this information? 
• Is any paper still being stored? If so, where is it located and for how many years back? If an organization still possesses records (even if beyond the retention rule), they must be producible. 
• Where do all users log in to view the complete patient chart, including clinicians, billers, and others? 
• Which legacy IT systems are still accessible, and what data do they contain? 
• What documents or set of documents do you need to meet HIPAA, legal requirements, and compliance rules? 

A best practice is to consult with legal and compliance departments throughout the process. The information gleaned is essential for defining the organization’s go-forward legal health record and designated record set. These findings also help determine which legacy systems and the data they contain will be migrated to the new EHR versus those that will be archived or maintained for access only. 

Collaborating with IT 

HI leaders are trusted, proven, and strategic advisors during any major IT system change. Especially when implementing a new EHR, their knowledge is essential to maintaining safe and compliant medical records. 

Data migrated into new systems carries a long-lasting impact on information quality and data integrity. Knowing what data will be migrated versus what will be maintained in archives is essential for keeping patient information complete, accurate, consolidated, and protected. 

Furthermore, the master person index (MPI) of any new system must be as clean as possible on day one of productive use. Less than a 1 percent duplicate record rate is considered a best practice. HI professionals, working together with IT teams, ensure this is the case. 

Now is the time for HI leaders to get involved in go-forward data management decisions. Weigh in, ask the right questions, and protect the integrity of your patients’ health information for years to come.

Todd Goughnour, MBA, RHIA, is Senior Vice President of Health Information Management at e4health. Rich Amelio is President at e4health.