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What does it take to build a state-of-the art information management (IM) function? The question was the subject of the Medical Records Benchmarking project completed early this year by the University HealthSystem Consortium (UHC) of Oak Brook, IL. Reasons for the study included the longstanding problems of backlogs and the challenges presented by industrywide pressures to convert to electronic medical records. The project focused on medical records departments at academic health centers.
The best performers excel in internal functions as well as customer relations: global enablers, meaning leadership and staff development within the records department; cost of operations; use of technology; record completion and availability; release of information; and physician satisfaction.
Here are the better performers and a few of their areas of outstanding performance:
University of Kansas — unbilled dollars, information release and coding. Vanderbilt University Medical Center — release of information and physician satisfaction. University of Utah Hospitals and Clinics — inpatient record completion time, loose filing, cost, and unbilled days and dollars. University of Texas Medical Branch, Galveston — re-engineered health information management department, introduc-tion of the team concept, and retrieval system. University of Virginia Health System — inpatient record completion cycle, unbilled days and dollars. Loyola University Medical Center — inpatient record completion cycle, unbilled days and dollars. Loyola University Medical Center — inpatient record completion cycle, unbilled days and dollars. NYU Medical Center and Georgetown University Hospital and Clinics — physician satisfaction. UCLA Medical Center, UCSD Medical Center, Shands HealthCare — coding. Medical College of Georgia Hospitals and Clinics, Brigham & Women’s Hospital, Harborview Medical Center — use of technology.
For more information, see: Best practices: What Works? D Carrier J AHIMA 1999; 70(7):61-68.
(Editor’s note: QI/TQM featured the re-engineering project at the University of Texas Medical Branch in the article "Faster billing time increases cash flow," May 1998, p. 62.)
People who have a personal connection with God or a Higher Power are more likely to experience better health. The finding comes from a random survey of more than 440 patients at a suburban family medicine clinic.
The researchers explain that a personal connection or an "intrinsic" spirituality is one that gives life meaning and guides choices. It shows more potent health benefits than "extrinsic" spirituality such as believing in God or having membership in a church or synagogue. The latter may or may not affect one’s internal motivations.
The investigators write, "Differences in health were greatest between patients having a low level of spirituality and those with either moderate or high levels." This confirms other research that spiritual commitment may enhance prevention of health problems. It may also strengthen the ability to cope with and recover from illness and surgery.
An unexpected finding centered on physical pain. Moderately spiritual patients experienced the least pain; highly spiritual patients, more pain; and the low-spirituality group experienced the most pain. Still, we have much to learn about this phenomenon.
"Spirituality may exert some influence over health," the researchers note, "but health is also likely to influence patients’ spiritual experiences, making relationships more difficult to untangle." They point out that the study is important because it shows significant differences in health and pain for those with various levels of internalized spirituality.
As for clinical applications, they offer that family physicians may want to ask patients questions like, "What aspects of religion/spirituality would you like me to keep in mind as I care for you?" or "How has your religious or spiritual history been helpful in coping with your illness?"
(For further details, see: McBride JL, Arthur G, Brooks R, et al. The relationship between a patient’s spirituality and health experiences. Family Medicine 1998; 30(2):122-126.)