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NURS 8210 Health Information Technology Project Assessment

NURS 8210 Health Information Technology Project Assessment


Today, the health care systems are reportedly encountering problems in the delivery of comprehensive and suitable clinical documentation that can satisfy vital care elements such as quality, clinical, and cost needs (Kostkova et al., 2016). Fundamentally, through health information technology (HIT) frameworks, it is possible to devise various data innovations to facilitate clinical documentation based on specialty. For instance, health care settings tend to seek verified electronic health records (EHRs) to attain vital meaningful requirements. Mostly, health care organizations rely on a vendor capable of providing best of breed EHR to facilitate provision of programs that are centered on the particular needs of the setting (Wager, Lee & Glaser, 2017). In a nutshell, the application of numerous EHRs is crucial in ensuring the delivery of patient-centered needs. However, physicians tend to emphasize mostly on patients’ needs at the expense of accomplishing the documentation precisely. However, the utilization of natural language processing (NLP) and computer-assisted coding (CAC) can potentially integrate the effort by stakeholders such as physicians, coders, and clinical documentation improvement specialists (CDIS) to complete and make the records clear, thus, fostering the attainment of quality, clinical, and financial needs.

The adoption of the International Classification of Disease, Tenth Revision, Clinical Modification and Procedure Coding System (ICD-10-CM/PCS) in the year 2015 facilitated increment in quantity of codes for patient diagnosis. Essentially, codes are proven to play vital roles in clinical documentation (Watzlaf, Alkarwi, Meyers & Sheridan, 2015). Consequently, due to the important roles of codes and the dynamic nature of medical services, the implementation of CAC programming arrangements is necessitated. The CAC is also integrated with EHR to ensure significant benefits for CDIS and coders (Amoia et al., 2018). The aim of this paper, therefore, is to describe the implementation of HIT in the medical services association, the inventive facets of the HIT system, and how the system support changes in the health care system.

Details of the Organization

The location of this medical service framework is in Georgia. The framework involves a total of six healing centers spread across Georgia, including more than one hundred areas for care provision. However, the anchor health care facility is located in Atlanta. The anchor health facility, which has a bed capacity of 488 was established over 100 years ago, and is serving as a private and non-revenue focused organization. Currently, the facility is among the top acute-care community health care settings and is rated among the best five facilities with outstanding patient outcomes. Besides, the facility has over 1,000 physicians that offer different care in areas such as cancer, transplant, women services, cardiac, nervous system science, and orthopedic.

The first setting is the physicians group. The physicians group is renowned as the pioneer of the multi-site practice in America acknowledged as patient-centered medical home. As such, the Health Care Incentives Improvement Institute recognized this facility as the first accountable care organization (ACO) in Georgia. The other health care facility is a 189 bed capacity community hospital which is credited by Health grades as one of the finest 50 hospitals in America. Cumulatively, the other hospitals constitute a 215 bed capacity community hospital, a 136 bed capacity community hospital, a 97 bed capacity hospital, and a 52-bed capacity community hospital. Taken together, there are more than 2620 physicians across these hospitals. Moreover, the physicians’ group has more than 170 physicians across Georgia (Piedmont Healthcare website, 2016). The organization is keen on innovation and has developed a telehealth technology which has been extensively used to reach remote areas. This project considerably relied on the perspective of Y. Brook who is the Director of Inpatient Coding for the above organization. Given the crucial position Brook is holding in the organization, the project expect to gain significant insights about the progress the organization has made regarding the clinical documentation and coding of the patient record. The 3M 360 CAC utilizing natural language processing for CDIS and coding software was implemented for a period of six months with the official launching in May 2015. The implementation involved training on aspect of enhancing clinical documentation to realize the requirements of ICD-10-CM/PCS.

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Key Factors for 3M 360 System Development

The 3M 360 system refers to an application used by quality divisions and income cycles within the medical services framework. In many instances, the evaluation of CDIS, coding, and quality indicators tend to occur in various parts of the facility, based on the operating healthcare system. For instance, they constitute components of quality, income cycle, or health information management (HIM).  According to Y. Brock, the coding and CDIS are integrated into income cycle, while quality indicators are dealt with by the quality change department. Therefore, the association predicted the utilization of ICD-10-CM/PCS. The rationale for implementing the CAC innovations emanated from the wanting suppliers’ documentation, severity of the disease and risk of mortality scoring, erroneous coding, patient safety indicator (PSI), coding sequencing, and need for confidence in data records.

NURS 8210 Health Information Technology Project Assessment

  1. Brock revealed that some physician facilities in the social insurance framework received remarkable poor ratings for long due to poor documentation of diagnosis. As a result, the social insurance framework opted to form a team to find innovations that eradicate such issues. The team comprised of the vice president of income cycle, the director of coding, the senior manager of clinical documentation change, the executive director of mid-revenue cycle, the executive of two doctor consultants, the director of HIM, and delegates drawn from CDIS, data frameworks, and coders. Besides, the chief financial officer (CFO) of the anchor hospital was selected as the good will ambassador to champion for the project.

The subsequent stage was the identification of requirements for evaluating distinct software. To ensure efficiency of audit records, the key requirement was incorporation between the EHR and CAC. In this interface, CAC ought to use natural language processing (NLP) to peruse the clinical documentation and propose coding of the record. Similarly, NLP should suggest avoidable PSI and hospital acquired condition (HAC) within the record through improved documentation. The system’s vendor needs to clarify the accuracy of the coding system including how it can be traced. The final prerequisite is to obtain significantly revealing devices. Consequently, the organization ensured the fulfillment of this prerequisite by sending a request for information (RFI) to a number of CAC vendors for response. Based on their response, the two CAC vendors were selected to give their presentations. The presentation was gauged against the checklist provided the organization to help in choosing the vendor.

3M 360 System Management

The need for efficiency in the3M 360 framework necessitated the designation of a professionals to provide necessary support, enhancement, and upgrades to the framework. In particular, the head of the server ensures that the server and the interfaces are maintained. On the other hand, end clients such as the CDIS, quality evaluators, and coders are tasked with the responsibility of accomplishing the testing of the framework. On their side, the in heads of clinical documentation and coding are tasked with approving access to new clients, alterations in the design, and discoveries from the framework. Besides, they are responsible for pursing new ideas and strategies from various clients and vendors of 3M to help in improving the effectiveness of the framework. The framework also involves preceptors in every unit who are responsible for accomplishing the preparation and training of the new consumers.

Information System Application Design and Development

The projections showed that the healing centers needed about 30% of the all the coding personnel or approximately $1.2 billion labor cost for ICD-10-CM/PCS coding. The 3M 360 system is fitted with tools to help in realizing the requirements of ICD-10-CM/PCS coding. These pre-arranged instruments resulted in a smooth outline and improvement of the system during implementation. Moreover, the system was also customized to include swim stream work lists for each physician’s facility. Besides, the suppliers and payers were also incorporated into the framework. Importantly, the system is remarkably flexible for adjustment. In the interview conducted with C. Earlier, the director of clinical documentation change, C. Earlier admit to have raised concerns that the outline of the questions used to contact suppliers did not meet the details of medical services frameworks, the coding authority, physicians’ counsel. As a result, the clinical documentation change initiative formulated new questions that complied with the requirements of the framework.

Decision Making in Health Information Technology

The effectiveness of the NLP in streamlining the CDI work process depends on the kind of the documentation that is fused in the framework from the EHR. As such, it is important for suppliers to bring their documentations positive basis. The 3M 360 framework comes with a “nosology” division that reviews all documentations and facilitates their breakdown by NLP. Y. Brock clarified that during the implementation process, a crucial leadership group was formed comprising of CDI executives, physicians’ counsels, and coding executives, and the central restorative informatics officer. This group was tasked with endorsing the improvements made to the documentation before submission to 3M to arrange for the NLP. Subsequently, CAC links to the documentation from the EHR, via NLP, to the auto-recommended coding.

During the project implementation process, the 3M experts occasionally worked with staff to enhance the framework. In particular, they provided advice on CDI and coding, assessing whether or not the devices in the framework are used effectively, administration and auditing of reports in the framework, and overall implementation. Consequently, the experts make recommendations to help in improving the work process. For instance, stressing on the essence of formulating effective working relationship between the data frameworks, CDI, and the coders to ease implementation and support for the framework.

Financial and Budgetary Issues

The organization made elaborate financial and budgetary plans to prepare for the ICD-10-CM/PCS. The corporate department of Revenue Cycle had allocated funds for coders and CDI nurses. According to Y. Brock, the acquisition of CAC and NLP software were facilitated through capital expense and their licensing was catered for by the administrative expense. On the other hand, cost of upgrading and fixes is catered for as part of yearly maintenance agreement.  As a result, the outcome of this elaborate financial arrangement has shown a promising future. The system has reduced workload for coders and CDI nurses, reduced overtime hours, and reduction in alteration in coding. Overall, the hospital system made an annual saving of approximately $500,000.  In facilities such as Piedmont Healthcare where the system has lasted for about a year, there is a reduction time spend for coding a chart and increase in employees satisfaction. Moreover, the utilization of CAC facilitates the management of increased workload without expanding the workforce. In a nutshell, the decline of variation in documentation and coding is crucial in optimizing the present and future reimbursement through value-based purchasing (Crews, Chamness, Terry & Helft, 2016).

Impact of Organizational and Political Issues

There is a growing opposition against the system because the documentation system does not appear to substantiate the inpatient confirmation. There is ineffective and disjointed documentation and coding that may not portray the exact therapeutic condition of the patient. For instance, the implementation of CAC and NLP at the Cleveland Clinic recorded 69% decrease in anticipated versus watched PSIs. However, despite the challenges, the association of human services is making effort to redesign the quality and case management divisions. Besides, the change management team is also strives to integrate quality, coding, case administration, and CDI to improve the outcomes.

On the national political arena, the presidential campaigns have started with Republicans and Democrats showing divergent ideologies.  President Donald Trump and the gathering pioneers are likely to have accord on human services. Consequently, Republican politicians may opt to reject Obama care, restructure Medicare, and revamp the Veteran’s Administration. On the other hand, Bernie Sanders of the Democratic Party has insinuated advancing the idea of Hillary Clinton to support changes to human services at the gathering phase.  The change includes integration of an open option for Medicare decisions. Nonetheless, a comprehensive and clear-cut documentation will be vital for reimbursement. In incorporation of CDI in outpatient care will help in surveying outlines within the human services framework within two years. It is also advisable to have measures in place to ensure proper coding of different high condition classes (HCC) since it is utilized in changing the Medicare capitation installments.

System Security

Essentially, the coding of the systems touches on various crucial areas such as quality and billing. Besides, the meaningful use of EHRs requires health facilities to ensure privacy and confidentiality of patient health information. Therefore, system security is imperative to only enable the certified users to access the 3M 360. Consequently, the healthcare centers including Piedmont Healthcare ensures the safety of the system by enabling sign on to various HIT systems. According to Y. Brock, the users can only access the 3M 360 system by signing on the network. The network login and passwords are changed after every six months. Besides, the users can only access the areas relating to their roles in the system.

Preparation of Users

  1. Brock explained that the training of the end consumers was conducted on the basis of their jobs and professional experience. The training is mostly focused on the use. The Piedmont Healthcare opted to train on the product without amending it since the CDI attendants and coders are highly competent. The participants were separated based on their job description. Coders were required to work distantly from home while CDI attendants were required to work from home for three days in a week and spend the rest of their working days at their respective healing centers. Likewise, the clients were designated workstations.

To avoid delay in coding the graphs for charging, the coding team was secluded into two teams to be trained on different weeks. The contracted coders were brought in to help in improving the coding staff during the training period. On their side, the CDI medical attendants were trained as a team. However, contracted CDI medical caretakers were hired to assist in remote auditing of graphs during the training period. The training lessons for both coders and CDI attendants were availed at the PC training space for five days. The first two days of the training focused on the key values of the 3M 360. However, the rest of the days focused on different areas such as use of the framework, checking on, learning on innovative initiatives, and coding of graphs.

Moreover, the training also indicated how the modifications can be achieved in the work process, both presently and in the future. The participants were familiarized with practical means of examining the documentation in the HER and auditing of records in 3M 360. Unlike the past where the clients would audit documentation to get the outcomes and medications and then proceed to peruse the codes in coding books, the new work process ensures that codes books are eradicated since the utilization of ICD-10-CM/PCS would render them obsolete and clients are trained to determine how to use computerized codebooks proposed by the framework. In a nutshell, the change proved problematic for many clients to effect. However, the reports on accuracy and reviews from framework were produced monthly. The outcomes for implementing the product include reduction in an opportunity to code an outline, increase in the accuracy of coding, and increase in questions.

Planned and Unplanned Downtime

The system breakdown is a common occurrence in many HIT projects. In this case, the breakdown can either be as anticipated or sudden and so, the CDI attendants and coders need to be equipped for continuous evaluation and coding to keep the system well maintained. However, the system breakdown cannot affect all aspects of the framework. For instance, while the system breakdown may have adverse impacts on timely billing provision, it may not affect the income cycle of the system.  The system downtime can also be caused by various factors such as PC infections, clearings, blackouts, fire, spills, dynamic shooters, and bomb risks. Essentially, it is approximated that virtually all clinics experience more than one spontaneous breakdown that lasted for many hours over a period of three years. Although sudden breakdowns may be difficult to mitigate without proper pre-arranged mechanisms, it is recommended that coding and CDI leaders should act immediately in case the anticipated breakdowns occurs to avoid interfering with routine working hours.


According to Brock, the 3M 360 system is designed to produce updates on a quarterly basis and thorough redesigns are done at standard intervals. The typical upgrade involves sending the discharge control to the coding and CDI leaders to enable introduction of the proceeding. Subsequently, a call is organized to review imminent update needed in the framework. The gathering then decides on time to connect the refresh. In an interview with Wendy Warren who is the application’s data framework investigator, she affirms that when the testing is over and validated, the gathering is expected to choose a time to refresh the product.

Response to Health Care Reform

Fundamentally, the adoption of CAC and NLP system was aimed at countering ICD-10-CM/PCS. However, the framework’s legitimate approximation is yet to be established. Since the system’s ultimate objective is counteract re-affirmations, 3M 360 produces daily report that helps in recognizing the patients with unremitting conditions such as congestive heart failure and to provide population health awareness for hospitalized patients to get appropriate medication to prevent re-infection before being discharged. The data obtained from the framework encompass vital details such as the gravity of the disease and mortality risks.  According to Brock, that data is presently shared via an answer to case administration to decide options to call the insurance agency to acquire authorization for consideration. Essentially, the esteem-based consideration connotes the covering of installment for the clinical deliberation of a group of patients and it integrates healthcare facilities, physicians, nursing staff, or restoration in the installment. Often, the installment can be narrowed or expanded based on the rates from the data conveyed two years prior to installment. Consequently, Y. Brock contend that it is important to accurately record complete documentation, PSIs, quality measures, and coding due to their ability to influence the intensity of installation.

Innovative Facets of the System

Primarily, coders and CDI nurses are the biggest beneficiaries of the innovation within the 3M 360. Operationally, the NLP has the capacity to work with different types of documentation and read the free-text from the organized notes in the EHR to transcription. The NLP then construe the notes by utilizing exceptional algorithms and is also capable of obtain codes from the documentation. Besides, NLP can offer logical suggestions from amorphous documentation. The NLP application can also facilitate working from a distant location due to its accessibility to all information in the system. Finally, the application has ensured massive cost reduction by eliminating the requirement of purchasing coding books for more than 60 users at an estimated cost of $ 150 per book.

Technology Innovation Recommendations

The adoption of the system in the health care system has resulted in a number of benefits such as client satisfaction, cost reduction, decreasing days to charge. The possibility of integration the documentation from EHR to the 3M 360 is a noble idea since the relationship creates one aspect of EHR to the framework. Besides, DRGs and coding also interrelate further into the budgetary framework. According to Y. Brock, to convey data presently to population welfare, case administration, and quality, the reports should be circulated within the 3M 360 framework and communicated to the relevant offices. As such, a request of upgrade has been relayed to 3M to incorporate this data into the EHR.


The changes in medical services and the implementation of ICD-10-CM/PCS have inhibited the organizations to select CAC and NLP frameworks to help them in enhancing the efficiency and the accuracy of coding. Regarding the financial arrangements, the cost of running the framework can be catered for by ensuring an annual financial allocation for the framework based on the benefits derived from the value documentation. The training of the clients involved the fundamental preparations for improvement of the system. In turn, the improvement ensured the meaningful use of the framework. For future survey considerations, the framework will be vital in providing crucial data such as areas for survey, and financial requirements for esteem-based consideration, including the clinical risks for esteem-based consideration.




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Crews, H. R., Chamness, A. R., Terry, C. L., & Helft, P. R. (2016). The Use of Claims-Based Data in Inpatient Public Reporting and Pay-for-Performance Programs: Is There Opportunity for Improvement?. The Journal for Healthcare Quality (JHQ), 38(6), 379-395.

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Piedmont Healthcare website. (2016). Retrieved from http://www.piedmont.org/

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