Sunday, August 22, 2010

I never took Criminal Justice Classes... So why am I a detective?

As an RHIT, I am the protector and keeper of the health records. With an EHR and bar-code scanning, as most large hospitals and even some small doctor's offices have, keeping track of records is relatively easy. If one provider has the record and it needs to go somewhere else, say for coding or documentation, you just look it up in computer, it tells you where that record has been scanned in, you go to that place, grab the record, scan it out and do your thing with it. Then if someone else needs it, they come to your area, scan it out, take it, and it becomes an easy efficient process for tracking records.
However, at the DOC, all health records are entirely paper. While each record does have a bar code along the spine, I think it's only used at headquarters. We have no bar codes, no scanners, no EHR. When we get the call-out in the afternoon, which is, all the provider's appointments for the next day, we go to the stacks, pull out the correct record, pull out the record's out-guide, sign the name of the provider it's going to on the out-guide, the outguide stays on the shelf in the stacks, and the records are delivered to that provider the next morning. The problem with this is, we have two doctors, and ARNP, six nurses, five psych associates and a psychiatrist, a dentist a dental hygienist, and two pharmacists. Oh, and an x-ray tech. If, say, the doctor has just seen an offender, then the nurse takes the record to do documentation and it's supposed to go in a bin or on a rack to go back to the medical records room. But, if the guy got in a fight and broke a tooth, then the dentist snags it and does his thing with it. Then, maybe the guy is issued pain medication and the pharmacist snags it from dentist. Finally, perhaps the psych associate had an appointment with the same guy in the afternoon, they have him sitting in the office, but no chart. They call me and ask me to pull the chart and get it to them, I check the stacks, find the out-card that says it was checked out to the doctor, I check with the doctor, he doesn't have it, I check the nurse's station and they don't have it, and IT'S ON! A facility-wide search for the record that wastes tons of time. Because we're short-staffed because a bunch of our people are in CORE, a mandatory six-week training class, I have no time for this! And apearantly this is a common theme throughout the DOC. A few weeks ago an e-mail was sent from one prison's RHIT on the coast to all the Washington RHIT's asking if and how we solved this problem at our facilities. Everyone responded saying they had the same problem and no one had any ideas. What to do? There has got to be a solution... I'm working on it.
Also, most people think that if an offender goes to prison, he's assigned to a prison, he stays there until his term is up, then he's released and that's that. Not so. Offenders are moving from prison to prison within the state all the time for many reasons, and sometimes they go to other states. If an employee of the prison and one of the inmates know each other, the inmate will be moved. If the inmate has a disease or injury that the facility he is at doesn't have the resources to effectively treat, the inmate will be moved to a facility that does. Sometimes, even if an inmate just wants to be closer to home so his family and friends can visit, he'll be moved. In the prison system, if an inmate moves, his health record goes with him. So we're always sending out charts for guys that are leaving, and recieving charts from guys that are coming in. Oftentimes we get loose filing from other facilities, for instance; they had a guy that had a blood test, and the guy left to come to my facility the day after he took the blood test, but the facility he was at didn't get the results for a week, so they sent it to us because we have him and his chart. And vice-versa. So, we have huge pile of loose-filing right now, before I came they were still short-handed and no one had time to do it, so now I'm here and it's my problem, and oh, it's becoming a problem. Especially with things like lab results that are sitting in loose-filing instead of in the charts to be used. So my staff and I have been whittling the pile down, actually making good progress, but we're running into the fact that many ( almost half) of those sheets in loose-filing belong to inmates that have already left, we don't have their charts anymore. So we look for it, we don't have it, then we have to go into the computer, find out where they are, or where their chart is and send it on. Again, rather cumbersome. And a few times a week, a chart is lost. Just completely gone. Then we have to really do our detective thing. We have to find out where the inmate was before, okay, did they send his chart with him, yes, it says they did. Did we recieve it? Well no, there's no documentation that we did. But that could be because they thought they sent it but didn't, or it fell off the bus while they were unloading at another facility before they came here, or because we really did get it but someone forgot to log it, or maybe he's a guy from the minimum security unit down the road and his chart is there... it goes on and on. So if anyone has any ideas for solutions, I would love to hear them. In the mean-time, this is a good example of what someone in my job does.

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