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Fame and Shame without a Name:
"HIM: When Your Healthcare Facility Closes or Medical
Practice Dissolves - Which Side of the Door Will You be On?"
Elizabeth Whitmer, RHIT, FAAMT
FHIMA Director
I can remember back years
ago in college we were given an assignment. It was to be no
longer than five sentences “What is the hardest part of
writing a story?” It was hard to believe that all
twenty-eight students in our creative writing class got it
wrong. It turned out to be just five words. “How to get it
started.” That was the answer. Believe me, I shall never
forget it. This plays a mirror like similarity to what I am
about to tell you. Due to the fact that it took me years to
try and put this into writing, with many months of recall
and hours of organization (intentionally leaving out certain
details), here it is for you.
As HIM professionals, many
of us remember the search for that perfect job. A place
where we can exercise every aspect of our education and hard
earned credential. Some of us remember that first job
opportunity. I thought I had found it. Personally, I
remember the exquisite entry and the magnificence of the
marble walls and floors that reflect your own image as you
pass through. You look up at a never ending ceiling, making
believe you can see a 22 foot Christmas tree, one that you
would only read about in books. It was so tall and
prestigious its prominent glow could take your breath away.
As you step forward you find yourself on an area rug beaming
with a logo so humbly displayed.
The prosperous years were
kind to our facility and spawned three additional satellite
offices. With a grand total of 61,600 square feet of
working space in all. A total of 148 staff and 23
physicians worked keeping it all running efficiently. The
flow of patients’ it received daily in each of its offices
was a reward duly earned. It was certainly something to be
proud of.
Needless to say there were
many issues of trial and tribulations, ups and downs, which
periodically arouse due to its increasing size. The facility
was certainly never at rest.
And then the end came. The
only way I can define the atrocious onset was as if the rug
man came and pulled that beautiful rug out from under us.
The facility was closing!
Patients’ were duly notified
when the official notification of the office closing was
posted in the newspaper. For many weeks, the HIM Department
telephones were relentless with their ringing. Staff spent
endless hours speaking with panicking patient’s advising
them what to do in order to obtain a copy of their record.
Other patients’ were advised that their record would be
shipped onward with their established physician.
Correspondence release of information paperwork tripled as
we tried very hard to maintain our energy and composure to
give our patients’ the feeling of assurance that they would
not be without their medical history.
As HIM manager it was
definitely apparent there was additional work to be done.
If you have ever participated in a breakup of this kind, let
me tell you, it was obvious it was going to happen when
there before us lay destined an ill-fated faction of 20
physicians’ (past partners’) at hand. A distribution of all
assets became language in a new realm.
Management instructions
appeared simple. We had to monitor hours and downsize work
areas. Each manager made an extreme effort to help make this
transition easy on the staff.
HIM duty was beginning to
look mammoth. I had an obligation before me which no one
could imagine. My department represented 47,000 active
medical record charts, 26,000 of prior years in storage
(in-house) 18,550 deceased also in storage and there was a
large amount in inactive storage. Distribution needed to be
divided and dispersed to the correct “physician of record.”
Some were resigning, others opening their own offices,
others moving out of state. I cannot begin to tell you the
number of identified boxes of charts that lined hallway
after hallway. I did my best to communicate with each
physician and make them realize the State regulations that
must be followed. The very interesting and amusing part was
they all had this concept that they could just come into the
Health Information Department and take what patient charts
they felt were theirs. Every evening all HI staff was
instructed to retrieve all charts and the ever secure
lockdown began.
As I began to organize and
plan the distribution process, I made many telephone calls
for support within my professional organization. Accessing
Huffman, and Abdelhak for help and/or instruction was my
initial response. I then turned to AHIMA and placed a
thread on the CoP. To no avail all of the responses that
came back were much too generic for what I was up against. I
had to be cautious and knowledgeable of every move I made to
protect these patient records. After countless meetings
with my CFO and administration, I succeeded in convincing
them of the correct State and Federal rules for the
protection of these patient records. With the help of the
facility’s law firm and the relentless issues raised we were
able to piece together a (RMA) Record Maintenance
Agreement. This became the major tool which finally allowed
me to reclaim some of my weeks of lost sleep.
Two years later we are
smaller (may I add that the carpet is nailed down.)
I hold my head high for the
fine job done by all involved. I find it overwhelming that
the CFO alone had in over 800 hours of his time invested. As
well as mentioning a physician average of 150 physician
hours as opposed to mental. Most of all it was a Health
Information Management professional learning experience. As
an additional result, we have in place a complete data base
of each and every chart, and its destination when
referencing for patient continuity of care, which took me
and my staff months to accumulate.
I found no book written with
guidelines for any of these experiences. I can only
recommend to you my fellow HIM professionals you need to get
your administration staff to understand our role in this
profession, and a good lawyer you can communicate with. Most
of all, the creation of the Record Maintenance Agreement
took precedence over much of what I had learned in college.
This agreement included every detail of the physician’s
responsibility. An area for each physician to sign
(witnessed) taking accountability of the patient medical
record charts they would take in possession. Our RMA turned
out to be 11 pages long; however, a tool that played a major
impact for HIM. We dotted our I’s and crossed all our T’s.
For the betterment of everyone, especially our patients’.
In closing I would like to
share: “We can fall and crawl behind a wall of this fame
and shame without a name. However, to find a need for the
lead that shows no greed-for we can’t see what is to be.”
- Thank you Julian Ritchey, an outstanding poet.
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