Assessing and Improving EHR Data Quality. Appendix A. Case Study: How One Hospital Improved Healthcare Data Quality in Its EHR

Holy Family Memorial Medical Center (HFM), a hospital within a healthcare network, has a hybrid record-part paper, part electronic. In l989, HFM initiated the computerization of the diagnostic areas of the hospital such as the lab and dictated reports. Through the years, system implementation has expanded to nursing, pharmacy, and computerized physician order entry (CPOE). The HIM department has used Meditech for chart location, chart deficiency, and transcribed reports, and plans to enable electronic signatures.

In 2005, a decision was made to scan all manual reports into the system to make them accessible in the patient care inquiry module. A core work group was established consisting of management information systems (MIS) department staff, as well as HIM department staff. Weekly meetings are held and minutes, available to all staff, are taken. Here's some lessons learned during HFM's transition.

Lessons Learned

  1. Identify all forms on a spreadsheet to keep the implementation process manageable. Use the spreadsheet as a working tool to document progress of form ID completion and establishment of bar codes.
  2. Work closely with the MIS department. Create a spreadsheet to document start dates for use of electronic forms and verify retention of the electronic forms to comply with governmental regulations and accreditation standards.
  3. Identify all processes that are affected by the electronic medical record, especially those outside of the HIM department, such as peer review, patient chart review or performance improvement data.
  4. Realize that the functions of the HIM department are not being eliminated but transitioned to the electronic format. In some cases, the functions have been expanded to verify quality and accuracy of the EHR.
  5. Develop guidelines for the use of electronic versus manuals forms as soon as possible.
  6. Have "super users" jump-start the project. These individuals are eager for the challenge and will identify concerns/problems and suggest solutions.
  7. Start small. HFM started scanning outpatient charts in 2005. The number of manual reports remaining in the outpatient charts is minimal. When we expanded to inpatient chart scanning, we had already identified many of the manual reports through outpatient scanning, but we ran a trial the week prior to the go-live date to verify that we had not overlooked a form or a process.
  8. Create simple step-by-step directions to access the EHR. Have a variety of users test the directions prior to distribution.
  9. Customer demand has changed. Once we went live with inpatient scanning, request for the information was immediate.
  10. Ensure redundancy of the EHR. HFM maintains an abstract of the paper record as a backup, since we do not have a redundant system. Our downtime procedure at present is to use the paper abstract.
  11. Communication and education-there is always room for more.

As a result of the EHR, the timeliness of information has changed and, therefore, so has the timing of work tasks within the HIM department. We presently are scanning inpatient records within 48 hours of discharge. The quality check is done the same day as scanning. All coding is performed online, as well as chart reviews.

Audits of access to the electronic record are more reliable than with the paper record, being password protected. Chart completion is not an issue. The physician is not restricted by location of the record in the HIM department. There is now the ease of completion at the office or within the hospital, any time of day that meets their schedule.

Kathy Schleis, MA, RHIT, CHP                       
Director of Health Information Systems                       
Holy Family Memorial Medical Center                       

Article citation:
Schleis, Kathy. "Assessing and Improving EHR Data Quality. Appendix A. Case Study: How One Hospital Improved Healthcare Data Quality in Its EHR ." Journal of AHIMA 78, no.3 (March 2007): web extra.