Last weeks (2/17/2011) clinical was cancelled because Kelli's kids were home sick, I didn't feel well myself.
This morning I sat with Yolanda, the Master Patient Indexer. Her job duties include professional standards such as working on the different queues within the McKesson's Horizon Patient Folder (HPF) to keep track of delinquent medical records, correct clerical errors- mostly duplicate patients, she monitors the Admission Operating Summery, which includes how many patients are being registered; every time a patient is registered (except in the Emergency Room), a print off is made and sent down to medical records automatically. Yolanda will check this several times during the day to put together a general census of the hospital. The summary also involves how much money Mercy Hospital is making and billing out. Her job duties also include changing new born babies names from "Thomas, Baby Boy" to their legal name, "Thomas, Jeffery", and to delete incomplete encounters, such as lab specimens never done.
Mercy Hospital uses terminal digit filing; using the last two digits, then the middle two and lastly the first two digits. They still keep microfilm in shelving from as early as the 1940's, and prior to 1990, Mercy would use the patient's Social Security number to create this number, and then occasionally also use their date of birth, if needed. After 1990, they moved to use computer generated numbers to create their filing system.
The most time we spent today was working on duplicate accounts. Yolanda would receive a print off of patients that had been targeted as having duplicate accounts- they need to wait for the patient to be discharged from the hospital and then wait an additional 3 days before she can do this. Once this time has passed she can find them in the McKesson's STAR system. Within the STAR software she is able to verify their name, address, date of birth and social security information. If she can not come up with correct account information with this, she then moves to use the HPF system, to check any forms that had been scanned into their system that may include; patient signatures, insurance cards or possible photo identification. After she has confirmed what information is correct (ex. spelling of legal name), she can then merge the accounts, which automatically also merge any codes or procedures done on either account, and if this does include procedures done, a copy of the final revision would be sent to lab and radiology so that they could see the patient information and change it on their side if needed.
The second part of my day was spent with Kelli Anderson, she explained in further detail how the HPF worked, since it is one of more important pieces of software that their department uses. Simply put, the HPF is what the coders at Mercy Iowa City may use to view the patient's medical record. Any forms that aren't a cold fed document (generated within the software), has a bar code added to the document, so that when it is scanned into the HPF system, the software "recognizes" where it's supposed to be saved. The major contents include; Searching patients, the Chart, a To Do list, and Deficiencies. Using Search, the coder is able to find a patients by using; name, date of birth, social security information or other demographics. Once found, they can view doctors notes, any forms scanned in or written into the software. Within the Chart, you can move notes or forms that may have been saved in incorrect locations. Under the To Do are the different queues. There are numerous queues, all involving patient records that are waiting be billed out. Some include Medicare issues; certain codes that are higher priority or are lacking information, special circumstances that need authorization from the patient before they can be sent out, a queue for Kelli (or the manager) to review because of confusing issues, and many other queues. The queues help the department keep a smoother control over operations. Lastly, Deficiencies are a list of doctors/PA/etc. that have incomplete notes that need to be reminded to finish so that a patients visit can be billed out. Every week the person in charge of this will go through the list of deficiencies and send a letter to that "doctor" to inform them that this needs to be completed. Incomplete notes may cause the author to be suspended from duties at Mercy Iowa City.
Also, after speaking with Kelli, I now know that Mercy Health Systems have; 1 Systems Manager, 2 floor managers, 8 coders, 8 transcriptions, and about 14 clerical/other type employees.
