We interviewed HIM leaders from across the nation to find out the secrets to their success. PJ Floyd, Director of Health Information at the Medical University of South Carolina, reflected on the changing role of HIM departments, the importance of cooperation across departments, and developing flexible staffing strategies.
What are your top day-to-day challenges facing you and your organization today?
First, the biggest challenge by far is the implementation of EHR. The purview of health information has expanded tremendously. We’re no longer the small medical records department in the back office. We have a huge responsibility and should be held accountable for standard-setting, from legal compliance related to documentation to defining what exactly a medical record is. HIM is now the department without walls.
We’re developing new relationships with other organizations, For example, we have telemedicine at the university. Our providers do telehealth consultations with hospitals and physicians in other areas and other cities. This begs the question: how do we define the medical record? How do we make sure all standards, across all organizations, are congruent and properly monitored? I find myself being pulled into daily research to help establish just what a modern HIM department looks like.
Our second biggest challenge is staffing. We are required constantly to do more with less. In order to offset the negative effects of the Affordable Care Act, for example, we have to find ways to increase productivity by 2-3% just to stay even. Reimbursement has all changed, and we’ve moved toward quality metrics and more stringent reporting. All of that is good, but it is challenging hospitals to look at productivity from a different angle and tighten up the reins on how we do business in order to find more flexible staffing solutions.
What strategies do you use to tackle these challenges?
We emphasize the possibility of advancement within our current staff members to motivate them to succeed. We provide opportunities and rewards, incentives for people to further their training and education. We encourage our more seasoned coders to work their way up with more and more specialized education.
We have a few positions that we engineered to be more generalist so they can cover several different departments and can flex depending on what the needs are each week. That’s another way we’ve really increased our own flexibility.
We also use contract coders, which can be perfect when you have a defined timeframe, such as someone on sick leave or maternity leave.
We also use contingent staff for auditing. When we have third-party auditors come in to dive into how our permanent coders are working, which we do on a regular basis, we bring in contingent staff to cover our gaps.
Contract staffing works best when we have open communication with their agencies and ongoing feedback. It really needs to be a constant conversation between contract coders and their companies.
What is your secret to your success as a HIM Director?
All leadership is essentially about relationships. Building credibility with your staff, admitting when you don’t know the answer to something, being open to new learning. I also am an MBA and a BSN, so I can both represent the business aspect of the position and understand clinical nuance when dealing with providers or documentation. Since HIM is so different today than it was just 10 years ago, and will continue to change rapidly in the next decade, having varied expertise and training is a huge advantage. It’s really about understanding how much more we are than a medical records department — Health Information really captures the breadth and depth of our work.
What’s your biggest career accomplishment?
Implementing the EHR was a several year process. We first began implementation in the beginning of 2012. Then, we updated all inpatient records in 2014. We continue to integrate EPIC on an ongoing basis, as different modules come into play. It’s really become an ongoing part of life in our department. It’s important for us to understand integration from many angles: what do my coders need? What standards do medical records need to adhere to? What do patients, physicians, and billing departments need — and how do those needs overlap or conflict?
I feel very good about the system I have in place. It’s been a multi-department effort, and we have built bridges and worked to cross department lines. The process has really empowered HIM as a department and brought out how integral we are to the smooth functioning of the hospital as a whole.
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