1. Awards/Recognition: Please list previous awards or recognition received by your HIM team.

• McKesson, ICC (Image Certified Customer) Award 2005 and 2008; • #48 out of Top 200 top major teaching coding Hospitals by Ingenix in 2007 • Team Quality Hospital Award, 2005

2. Initiative: Provide examples of your team's initiative to improve the work environment/profession as a whole.

Initiatives include decrease of physician deficiency rates from an average over 40% to an aggregate average of 6.65% for our Health system. Provide working environments so that over 70 of our 140 employees are able to work remotely and telecommute. Centralize and brought in house our Release of Information and produce revenue that covers our internal costs. Not only provide document imaging solutions for our medical records, but also serve as a document imaging solution for charge sheets, eob's, patient accounting correspondence and old surgery staffing schedules Provide weekly communication and praise to the staff by sending out via email a "Friday Update" to notify all staff where each areas is at with goals and to acknowledge special efforts by staff by placing them in our "Caught in the Act of Excellence" categories. Collaborated on History and Physical Quality Committee to increase number of preoperative H&Ps dictated which would be available in the electronic medical record prior to surgery and reduce TAT from 24 hour goal 5 years ago to current goal of 6 hour TAT, with average goal achieved being 4-6 hours Use voice recognition (Powerscribe) as a tool to improve radiology report turnaround and gain MT resources for redeployment to other work types in order to improve overall turnaround for all work queues. Went from approximately 50% compliance for physician self-edit to current 95% compliance, with several facilities in health system achieving 100% compliance for physician self-editing.

3. Adaptability: How has your department shown that it is adaptable to the changes and "upheavals" currently going on in the HIM field and health care in general? What has your department done to support the future implementation of an electronic health record system?

Our department has illustrated it is able to adapt with change by providing seamless transitions from paper record environments to electronic environments to 9 out of our 11 Health System hospitals over a 7 year period of time. During this time we have centralized many functions which include Coding, Release of Information and Transcription. With a larger pool of staff we are better able to streamline processes as well as provide consistent education and support as well as better customer service. To support the future implementation of an electronic health record system our HIM department has a Project Manager and four Functional Analysts involved in the daily testing, review, build and implementation of all of the electronic health record systems to insure required Regulatory agency elements are captured and the products are user friendly. We are also a vital piece in the training of physicians in order for the HIM staff to explain what is expected of chart completion and our process. Analysis formed a committee to create an electronic Analysis Manual to assist with compliance questions and application questions. The manual is updated monthly in regards to changes with rules and regulations and regulatory issues. Since many not all analysis staff are located in one location and some also telecommute, this was a great tool to communicate current updates and information on physician trends. The manual has illustrated a reduction in errors and an increase in analysis accuracy and physician satisfaction.

4. Teamwork: Provide examples of how your team has worked together to accomplish certain goals.

Each Hospital is unique in its own way but we all strive for consistent standards that we can measure and improve upon. By using what is called a Balanced Score Card, we are able to identify measures that each Hospital can monitor, provide results and create action plans based on outcomes. We then share this information with each other, as well as with our staff so we can learn from one another as well as with other departments. We also meet monthly to collaborate on any projects and talk through process. A specific example of how ourteam has worked together to accomplish a certain goal is illustrated in our decline in deficiency rates. Our Project Manager is integral in insuring the product in which the physicians can complete their records is user friendly and there is a consistent training tool. This information is then provided to all analysis staff, physician liaisons, and managers to assist in physician training. We then call upon all team members to provide daily direct support to questions physicians may have and provide weekly communication as to what charts are needed for completion. The electronic manner in which we are able to capture signatures, text editing, physician queries, AJCC staging, and dictation completion allow this entire process to run very smoothly. To encourage staff understanding during the training process analysis has developed a Quality Control Email distribution to assist HIM employees and new analysts with chart compliance questions. The response time to questions and analyzing priority chart is under 24 hours for all requests.

5. Above and Beyond: Provide exemplary instances of how your team has gone "above and beyond" to make a difference in your facility.

We have become involved in many committees and IT projects outside of our department to help streamline processes, including a History and Physical committee. The committee was initiated 4 years ago in response to a Joint Commission Survey. HIM has worked collaboratively with all clinical areas and physicians to insure that every procedural case performed at Saint Luke's Hospital now has an appropriate History and Physical. HIM was instrumental in creating a System Clinical Documentation Committee to standardize the content, format and publishing of System physician order Sets as well as clinical documentation. With the progression of improvement we have also initiated the Microsoft Office application SharePoint to better utilize our search and publishing capabilities as well as workspace efficiency. HIM was approached by our large Cardiovascular Consultant group to increase transcription service to include discharge summaries which were being typed by their own transcriptionists. Their turnaround (TAT) was at about 4 weeks outside of goal. HIM managers met with CCI managers and together we developed new work types, work flow, dedicated MTs to CCI specific work profile, and wrote policy. The project went live in March 2005. Within days we had surpassed all TAT expectations for CV Lab reports and discharge summaries set at 24 hour TAT, averaging 15 hours and 14 hours respectively from time of dictation to time of transcribed document being available on the system. We also worked with IT on this project to create interface between our EMR and their office EMR, thus, saving clerical time as reports no longer had to be printed and mailed. Transcription was approached by the large hospitalist group of physicians to design work types specific to their needs in order to improve TAT on H&P, consults, and discharge summaries. This service also provided nocturnalist service and they identified need to have H&P dictated during third shift completed and available in the EMR by 9:00 a.m. the following morning so that physician assuming care from nocturnal hospitalist would have current information detailed in H&P. The work types were designed and special work profile was created in transcription in order to dedicate staffing to this work pool. Again, within days we were exceeding TAT goal expectations and currently average 4.5 hour TAT for H&P, 8 hour TAT on consults, and 12 hour TAT on discharge summaries. An added benefit to this initiative was improved turnaround for reports in our other discharge summary profile to include ED discharge summaries and short stay summaries. We have reduced our TAT from an average of two weeks out of goal several years ago to consistently averaging 48-55 hour TAT since we designed both the CCI and hospitalist profiles. The goal for discharge summary profile is 72 hours. HIM transcription was approached by our Rehab Therapy Department at a northland facility to provide transcription to therapists who were using forms to hand write initial evaluations and discharge summaries in order to reduce time spent creating reports and also complete reporting in a timely manner - the handwritten forms were being completed up to a week after patient was seen initially. The transcription manager met with lead therapists and discussed volume, templates, TAT goals, report delivery to referring physician, etc. She received copies of templates which were copied into the transcription application, designed work types, set realistic TAT goals, and project went live approximately 2 years ago. Our TAT goal was set at 24 hours and we are achieving on average 12 hour TAT for initial evals and 16 hour TAT for OT/PT discharge summaries. Other benefits include improved legibility, much reduced time spent by therapist's handwriting these 4 page reports, legibility, and access to this information in EMR much ahead of TAT expectations. Recently, we have broughttwo more facilities online in regard to providing transcription service for OT/PT rehab departments. A Physician Signature Database was developed using Microsoft Access to provide a user friendly process for all HIM employees, to verify physician signatures, specialties, and campus site(s). This transitioned from a paper to electronic process to provide up to date access of current physicians, residents and practitioners signatures

6. Knowledge: Provide examples regarding how your team has shown the ability to learn new technologies (software applications, etc.).

Our Department is continually learning new technologies. In 2001 we implemented Horizon Patient Folder as our Document Imaging solution at Saint Luke's Hospital. Thissame application was then rolled out to another 8 Hospitals over the next 7 years. During this same time, we have learned new applications such as Powerscribe and Dictaphone ExSpeech and how to edit as opposed to just transcribing; we have implemented a Physician's Portal to house all applications in one location for ease of physician use; and finally we are continually performing upgrades and/or integration of new Horizon products to streamline the electronic medical record. These new integrations include Horizon Surgical Manager, Horizon Expert Documentation, Horizon Emergency Care, the Release of Information Module within Horizon Patient Folder, ILE (Integrated Link Engine??) in order to have Admitting scan all drivers' license, insurance cards and outpatient order forms; DX viewer and PACS for Radiological image viewing remotely, any others?? Chart Analysis has also learned new applications that are utilized for chart documentation but are not applications that currently interface or are implemented for all clinical service areas. This greater knowledge base and resource pool allows for quicker retrieval of missing documents for chart completion, including Physician EMR's that work for the Health System, Prosolve (for printing out Echos, TEES, CC Nuclear Radiology for stress tests), and GE Centricity system for CV lab documentation.

7. Additional Information: Why else does your team deserve to be recognized as the 2008 HIM Team of the Year?

Our team deserves to be recognized as the 2008 HIM Team of the Year because our Teamwork is never ending. Our Team has grown from a single department at one Hospital in 2001 to 11 HIM departments working together to solve problems and help each other every day. We are no longer working in silos separate from each other but really as 1 HIM department with lots of spokes to one wheel. While not many of our accomplishments were completed in just this past year, we believe we are the Team of the Year because we have worked so hard over the past 7 years to accomplish the great product that we have today - several HIM departments working as one.