Becker's Hospital Review

26 Special Focus on HIT & HIM Learning From the Best: What HIM Looks Like at Geisinger, Intermountain By Sabrina Rodak W hile many healthcare facilities are at the stage of implementing health information technology such as electronic health records, computerized provider order entry and patient portals, others are moving beyond the technology itself to the management of information through technology. Health information management enables health systems to use the data captured through HIT to improve patient care and to make administrative processes more efficient. HIM at Geisinger Spotlight on patient-focused HIM Danville, Pa.-based Geisinger Health System is known for being on the cutting edge of innovation in healthcare, piloting bundled payments, paying physicians for performance, developing intellectual property and more. Its work in HIM is no different. From social media to a data warehouse to transparent physician notes, Geisinger is exploring new ways of using HIT to improve care. Steven Strongwater, MD, chief transformation officer at Geisinger, shares some of the ways the system uses HIM to promote shared decision-making between patient and provider. Data warehouse Geisinger has a data warehouse that integrates data from the EHR and other sources, such as administrative systems, to guide clinical decisions, identify gaps in care and manage population health. For example, providers can use the data warehouse to identify patients with chronic conditions, such as diabetes or high blood pressure, who need help managing their disease. Care team members can then intervene to ensure patients receive the appropriate services. OpenNotes OpenNotes is a web-based platform that allows physicians to share their visit notes with patients electronically. Geisinger, Harborview Medical Center in Seattle and Boston-based Beth Israel Deaconess Medical Center participated in a one-year pilot of OpenNotes led by Tom Delbanco, MD, and Jan Walker, RN, of BIDMC. Following the pilot, Geisinger launched OpenNotes systemwide in May. Currently, more than 100,000 patients view the notes of more than 500 participating Geisinger physicians in primary care, pediatrics and other specialties. "We think this will be enormously transformational in activating patients, [achieving] shared decision-making, correcting misunderstandings and improving the content of medical records," Dr. Strongwater says. Anticipatory management and predictive analytics Another project Geisinger is working on is the anticipatory management program, which aims to use information in the data warehouse to optimize the use of outpatient visits by conducting needed tests beforehand and making sure patients know what to expect for the visit. For example, a diabetic patient might have lab tests done prior to the outpatient visit and a nurse may perform a diabetic foot exam (as part of a diabetic bundle of care). This way, the physician discusses the results with the patient, and together they can plan next steps. In addition, Geisinger is working to use information from the data warehouse to predict patients' risk for certain conditions so they can make more informed healthcare decisions. For instance, a risk prediction algorithm could identify patients at high risk for lung cancer, which may trigger a recommendation to get a CT scan, according to Dr. Strongwater. "Our ultimate goal is to arm patients with enough knowledge to be active participants in deciding how to approach their own care," he says. HIM at Intermountain Spotlight on efficiency-focused HIM Salt Lake City-based Intermountain Healthcare is also leading innovation in the industry through its Institute for Health Care Delivery Research, Invention Management Office and newly launched Healthcare Transformation Lab, among other platforms. While Intermountain also uses HIM to reach out to patients, and has an HIT-based patient activation plan in the works, Mary Staub, the system's HIM director, shares best practices for using HIM to improve administrative efficiency. Centralization A best practice for organizing HIM departments is to centralize operations within each department. Intermountain centralized its transcription and coding departments to make the best use of staff, improve efficiency and lower costs. Centralizing operations also facilitates standardization of processes across Intermountain's 22 hospitals and other sites of care. For example, all transcriptionists and physicians use the same template for transcribing. In the past, Intermountain had 42 different vendors for transcribing, according to Ms. Staub. Managing government audit requests Intermountain streamlined the process for responding to medical records requests by federal government groups such as recovery auditors, zone program integrity contractors, Medicare administrative contractors and more. Intermountain worked with the appropriate government agencies to establish one address at Intermountain for all record requests. Designated staff members check the mailbox every day and scan any requests, which are then emailed to leaders at all the facilities as well as a vendor that handles the release of information from Intermountain. "Something as simple as having a central mailbox to receive all the requests" made a huge difference in the turnaround time for meeting requests, Ms. Staub says. Measurement Another best HIM practice is to establish metrics and track performance. Intermountain uses dashboards to measure transcription and coding turnaround, document completion rates and productivity against goals. Weekly reports on these measures keep Intermountain's leaders up-to-date on performance and consistency within HIM. Communication with other leaders Ms. Staub meets regularly with Intermountain's CMO and the medical director's council to discuss clinical and financial HIM standards. The CMO works with the medical staff to gain buy-in for HIM initiatives, such as making patients' records available to patients online, and to ensure standard processes across physicians. Ms. Staub works with the financial services leaders to discuss standard billing and other financial processes.

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