Domain 6 Questions Flashcards
An HIM department is projecting workforce needs for its document scanning process. The intent of the department is to scan patient records at the time of discharge, providing a 24-hour turnaround time. The hospital has an average daily discharge of 120 patients, and each patient record has an average of 200 pages. Given the benchmarks listed here, what is the least amount of work hours needed each day to meet a 24-hour turnaround time?
National Benchmarks for Document Scanning Processes
Function
Expectations per Worked Hour
Prepping
340-500 images
Scanning
1,200-2,400 images
Quality Control
1,600-2,000 images
Indexing
600-800 images
100 hours
146 hours
1,000 hours
3,740 hours
The question is asking for the least amount of hours needed to meet the 24-hour turnaround time. The average discharge in a 24-hour period is 120 patients, and the average number of pages for each patient chart is 200. So, 120 × 200 = 24,000 pages in a 24-hour period. Each chart must be prepped, scanned, checked for quality, and indexed. The highest number of pages that can go through all these processes in an hour would be: 500 images in prepping: 2,400 images in scanning 2,000 images in quality control; and 800 images in indexing.
• 24,000 / 500 = 48 hours needed for prepping
• 24,000 / 2,400 = 10 hours for scanning
24,000 / 2,000 = 12 hours for quality control
. 24.000 / 800 = 30 hours for indexing
• 48 + 10 + 12 + 30 = 100 hours, at least, needed each day to meet a 24-hour turnaround time (Prater 2020, 628-629).
An audit of the document imaging process reveals that the HIM department staff is scanning 250 pages per hour and indexing 114 pages per hour. If the department is meeting its performance standard for scanning, but is only meeting 60 percent of the indexing standard, how many more pages per hour must be indexed to meet the indexing standard?
45.6 pages
68.4 pages
76 pages
190 pages
Performance standards should be based on both accuracy and volume. In this situation, 114 / 0.60 = 190; 190 -
114 = 76 more pages will need to be indeed to meet the productivity standard (Kelly and Greenstone 2020, 183).
Which phase in the project life cycle is where the project shifts to become an integrated part organizational operations?
Closure
Execution
Initiation
Planning
In closure, the new system or process is used by the customer. This is the phase in which the project shifts to become an integrated part of organizational operations. During the operational phase, management must continually monitor performance and determine whether the new system or process meets established performance criteria (Shaw and Carter 2019, 371).
In designing input by clinicians for an EHR system, which of the following would be effective for a clinician when the data are repetitive and the vocabulary used is fairly limited?
3 Drop-down menus
Point and click fields
Speech recognition
Structured templates
Speech recognition
Speech recognition can be very effective in certain situations when data entry is fairly repetitive and the vocabulary used is fairly limited. As speech recognition improves, it is becoming a replacement for other forms of dictation. In some cases, the user reviews the speech as it is being converted to type and makes any needed corrections; in other cases, the speech is sent to a special device where it generates type for another individual to review and edit (Sayles and Kavanaugh-Burke 2021, 20).
The HIM director is part of the revenue cycle management team. The discharged not final billed days are increasing because discharges are increasing. The number of coding staff is five. In an effort to increase productivity, the HIM director is researching staffing alternatives. With the implementation of an electronic document storage system, telecommuting has been suggested as an alternative. Studies report that coding productivity can increase as much as 20 percent with telecommuting. Given that discharges have increased from 100 per day to 144, how many more full-time equivalents (FT) would need to be hired if the department went to telecommuting?
0.5 FTE
0.75 FTE
1 FTE
2 FTEs
The productivity increase with telecommuting is 20 percent. The facility has five coding professionals who are currently coding a total of 100 charts a day. With this 20 percent increase, each of the existing five coding professionals can code four records more per day each (a 20 percent increase). This amounts to 120 charts: 24 x
5 = 120. If the discharges increase by 44 charts, the facility would need one more FT in the telecommuting
staffing model, since each coding professional can code 24 records per day (White 2020, 157-158).
This planning technique provides a structure that requires the project team to identify the order and projected duration of activities needed to complete a project:
Gantt chart
Flowchart
Pie chart
PERT chart
The PERT technique provides a structure that requires the project team to identify the order and projected duration of activities needed to complete a project. The most helpful element of PERT is that it identifies those critical activities that must be completed on time in order for the entire project to meet its final deadline (Shaw and Carter 2019, 370).
The HIM and IT departments are working together to justify additional employee password training. The additional training would cost approximately $100,000 with the expectation that password calls to the IT help desk will be reduced by 20 percent. The IT department has done a cost analysis of help desk calls solving password issues. Given this data and approximately 40
password calls per day, can the cost of the additional training be justified?
Costs Associated with Each IT Help Desk Call to Resolve Password Issues
Personnel
Cost
User’s time-30 minutes
$15
Telephone cost–30 minutes
$2
Call Desk time- -30 minutes
$16
Call Desk IS facilities time
$17
Total
$50
Training will provide $146,000 savings in help desk support and can be justified.
The results of training will provide $365,000 savings in help desk support and can be justified.
The cost of training will be recouped in less than half a year and can be justified.
The cost of training is not justified because qualitative results cannot be measured to calculate a return on
investment.
Current cost: $50 × 40 calls per day = $2,000 per day × 365 days = $730,000. Cost with reduced number of help desk calls: $50 × (40 × 0.80) calls per day = $1,600 per day × 365 days = $584,000, or a savings of $146,000. Training costs of $100,000 will be recouped and a savings of $46,000 realized (Gordon, L. L. 2020a, 541-542).
The HIM director has put together a group of department employees to develop coding benchmarks for the number and types of charts to be coded per work hour. The group includes seven employees from the analysis, transcription, release of information, and coding sections.
No managers are included on the team because the HIM director wants a bottom-up approach
to benchmark development. What fundamental team leadership mistake is the HIM director making with composition of the team?
Insufficient knowledge of team members
Too many team members
Unspecific team charge
Too few team members
Insufficient knowledge of team
Whether selecting a permanent staff team or members of a team for a short-term project, making the right choice is fundamental to the team’s success. Putting together a team involves understanding the challenges to be faced and considering all of the perspectives, experience, and knowledge that will be needed. The members of the team should be selected for what they can contribute to the team. Member selection should not be based purely on job title; rather, team members should be selected for the tasks that they actually can perform and the responsibilities they can carry out (Gordon, L. L. 2020b, 596-597).
City Hospital has implemented a procedure that allows inpatients to decide whether they want to be listed in the hospital’s directory. The directory information includes the patient’s name, location in the hospital, and general condition. If a patient elects to be in the directory, this information is used to inform callers who know the patient’s name. Some patients have requested that they be listed in the directory, but information is to be released to only a list of specific people the patient provides. A hospital committee is considering changing the policy to accommodate these types of patients. In this case, what type of advice should the HIM director provide?
Approve the requests because this is a patient right under HIPAA regulations.
Deny these requests because screening of calls is difficult to manage and if information is given in error,
this would be considered a violation of HIPAA
Develop two different types of directories-one directory for provision of all information and one directory
for provision of information to selected friends and family of the patient.
Deny these requests and seek approval from the Office for Civil Rights.
Deny these requests because screening of calls is difficult to manage and if information is given in error,
this would be considered a violation of HIPAA
The HIPAA Privacy Rule allows individuals to decide whether they want to be listed in a facility directory when they are admitted to a facility. If the patient decides to be listed in the facility directory, the patient should be informed that only callers who know his or her name will be given any of this limited information. Covered entities generally do not, however, have to provide screening of visitors or calls for patients because such an activity is too difficult to manage with the number of employees and volunteers involved in the process of forwarding calls and directing visitors. If the covered entity agreed to the screening and could not meet the agreement, it could be considered a violation of this standard of the Privacy Rule (Thomason 2013, 105).
As part of Community Hospital’s organization-wide quality improvement initiative, the HIM director is establishing benchmarks for all the divisions within the HIM department. The following table shows sample productivity benchmarks for record analysis the director found through a literature search. Given this information, how should the director proceed in establishing benchmarks for the department?
Sample Productivity Benchmarks
Productivity Benchmarks
Function
Per Hour
Low
Average
High
Analysis (charts per hour)
Inpatient
Observation /outpatient
5
8
14
20
60
surgery/newborn/maternity
Other outpatient
20
120
Determine whether the source of the benchmark data is from a comparable institution.
Use the low benchmark example as a beginning point for Implementation.
Contact the hospital statistician to determine whether the data are relevant.
Use the average benchmark example as a beginning point for implementation.
Determine whether the source of the benchmark data is from a comparable institution
Comparing an organization’s performance to the performance of other organizations that provide the same types of services is known as external benchmarking. The other organizations need not be in the same region of the country, but they should be comparable organizations in terms of patient mix and size (Shaw and Carter 2019, 70).
Which of the following is a positive aspect of using employee self-appraisal as a source of data for performance appraisal?
Employees are in the best position to provide objective review without overstatement.
The supervisor is kept informed of the employee’s accomplishments.
Appraiser and employee training on the purpose and procedures of this process is essential.
Peer pressure of evaluation can motivate team members to be more productive.
The supervisor is kept informed of the employee’s accomplishments.
Employee self-appraisal provides the opportunity for the employee to keep the supervisor informed of accomplishments and issues (Prater 2020, 632).
In designing input by clinicians for an EHR system, which of the following would be effective for a clinician when the data are repetitive and the vocabulary used is fairly limited?
3 Drop-down menus
Point and click fields
Speech recognition
Structured templates
Speech recognition can be very effective in certain situations when data entry is fairly repetitive and the vocabulary used is fairly limited. As speech recognition improves, it is becoming a replacement for other forms of dictation. In some cases, the user reviews the speech as it is being converted to type and makes any needed corrections; in other cases, the speech is sent to a special device where it generates type for another individual to review and edit (Sayles and Kavanaugh-Burke 2021, 20).
The RHIT supervisor for the scanning and quality control section of Community Clinic is developing a staffing schedule for the year. The clinic is open 260 days per year and has an average of 500 clinic visits per day. The standard for scanning records is 50 records per hour.
The standard for quality control of scanning of records is 40 records per hour. Given these standards, how many productive hours will be required daily to scan and quality control records for each clinic day?
10 hours per day
11.11 hours per day
12.5 hours per day
22.5 hours per day
Timeliness of the scanning and quality control processes should be monitored. In this situation, each clinic visit represents a patient record that will need to be scanned and quality control completed. The calculation is: (500 /
50) + (500 / 40) = 22.5 hours per day (White 2020, 156; Prater 2020, 628-629).
A hospital currently uses the patient’s Social Security number as their patient identifier. The hospital risk manager has identified this as a potential identity fraud risk and wants the information removed. The risk manager is not getting cooperation from the physicians and others in the hospital who say they need the information for identification and other purposes.
Given this situation, what should the HIM director suggest?
Avoid displaying the number on any document, screen, or data collection field.
Allow the information in both electronic and paper forms since a variety of people need this data.
Require employees to sign confidentiality agreements if they have access to Social Security numbers.
Contact legal counsel for advice.
Avoid displaying the number on any document, screen, or data collection field.
It is generally agreed that Social Security numbers (SSNs) should not be used as patient identifiers. The Social Security Administration is adamant in its opposition to using the SSN for purposes other than those identified by law (Sayles 2020b, 84).
