Medical_Records_Manager

Medical Records Manager By: Samantha Romaine Denver Health is known as Colorado’s “safety net”. The hospital provides care for the billions of uninsured people in the state. Records show that five percent or approximately 150,000 individuals receive their health care at Denver Health. The hospital its self is over 1.5 million square feet with more than 477 beds. The services Denver Health offer is childbirth, pediatrics, eating disorders, emergency medicine, infectious disease, neurosurgery, along with many more. I was given the opportunity to interview one of there most valuable employees, Mrs. Megan Nelson. She was able to sit down with me and discuss Denver Health over webcam. We talked about her daily routine and what it took for her to be where she is today. It was not only informative to me but also a motivator which I’m sure I will remember through out my journey to becoming part of health care information technology. Not only are there many aspects to health care, but there are tons of moving pieces that make everything possible. Not only do you have to be able to perform your own job, but you must to some extend understand what it takes to perform others around you as well. In anything that you do in your career you should always strive to be the best at what you do. Mrs. Nelson not only confirmed that for me and showed me that through hard work and dedication you can be the best at whatever you do. Mrs. Nelson described to me the systems that are used, who use which systems and the security that is used to keep the patient records safe and secure. I would first like to describe in detail what her job is and how she got where she is today. I asked her what he job title is and her response was medical records manager. I had done some research on the career and was extremely interested in the profession. A medical records manager is responsible for so much. Anything from maintaining accurate records of patients’ medical histories, past treatments, and vital statistics is the day-to-day task of a medical records manager. It is also their job to oversee the creation (How to become a medical records director/manager) and updating of these records. That’s makes sure that these records are the most accurate and current as they can be in order to run a successful medical facility ensuring patient safety. In larger facilities such as the one Mrs. Nelson works for the medical records manager supervises medical billing and coding and case management personnel. Usually they are also responsible for enacting and retention polices, ensuring that procedures and regulations are being followed. (Jobs in Healthcare Adminstration) Mrs. Nelson also added that while she has a lot pride in her work and loves what she does she said that it is very nerve racking being responsible for what others do. She explained that the mistakes that others make at her job not only has consequences for her but it could be fatal to a patient. “Something as simple as accidently checking a box that shouldn’t be check could kill someone and the idea of that terrifies me” and she continued with “It’s not really the fact that I could lose my job that bothers me but it could end someone’s life”. She even admitted to loosing sleep some nights. Right as the end of the conversation about her daily task she asked to make sure I mentioned something very important in the project. “Privacy is the very important when working anywhere near someone medical records” stated Mrs. Nelson. Something like leaving your computer open when you go on lunch break can leave a patients’ information open for the world to see. She said that when a patient’s privacy is breeched termination and lawsuit is very likely. “Simply go to www.google.com and search recent lawsuits for breach of medical information. You will be surprised to find pages and pages of current lawsuits of patients suing for their private information getting into the wrong hand.” A medical records manager position most of time requires at least a masters degree in a medical discipline or business related field. Experience in a medical records environment is usually required. It’s also common for some facilities or agencies to require certifications such as Registered Health Information Administrator (RHIA) or the Registered Health Information Technician (RHIT). RHIA is a voluntary credential that demonstrates a high level of professionalism and shows expertise in the health information management field. The RHIA exam includes procedure and diagnosis coding, federal regulatory guidelines, reporting requirements, privacy and confidentiality issues, and data quality. Some schools provide this test to their students while in other cases you are required to independently seek the test-taking site. Those are both offered by the American Health Information Management Association. A medical records director would work generally in a comfortable office setting. In fact this is one of the few jobs in health care were there is no direct hands-on patient care. A medical records director should expect to work a normal 40-hour workweek. Of course like most careers there could be times where overtime in required. Medical record directors generally mean a supervisor position, and since most health care facilities are open 24 hour a day, 7 days a week it could mean that you would work 1st, 2nd, or 3rd shift. As far as the career growth of medical records director, the expectation is much higher than normal. In a ten-year period it’s expected to grow 20%! The expected wages could be anywhere between $26000 to $42000 depending on what type of health care facility you chose to work at. In May of 2008 the median wages where $30610. Numerous sources say that a strong understanding of technology and computer software will be in high demand and help secure you career in Health care Information technology. Denver Health was founded in 1860 and has grown to be one of the states’ busiest hospitals with more than 25,000 admissions annually. It’s home to the Rocky Mountain Regional trauma center, which was recognized by the Colorado Department of Public Health and environment for having the best survival rates when it came to trauma for the entire state of Colorado. Denver Health operates and supervises the Denver 911 medical emergency system. According to records Denver Health Paramedics answered more than 78,000 calls for emergency assistance. They also transported almost 54,000 patients to twelve area hospitals. Denver Health Community Health Services prides itself for treating more than 355,000 outpatient visits per year. Denver Health provides thirteen health centers that provides medical care to elementary, middle and high school students. One of the things that make Denver Health a top of the line facility is that it offers many alternatives to the rather costly emergency room visits. The Rocky Mountain Poison and Drug Center handles minor poisoning emergencies as well as minor emergencies. It also provides a twenty-four hour nurse line more than 85,000 receive free and confidential answers to their health related questions. Lastly Denver Health is known for is the lowest hospital morality rate lowest trauma mortality and an amazing zero maternal mortality. One thing that stood out for me during the interview was that she could not tell me enough of how much she and her fellow co-workers loved their job and what they did on a daily basis. Some of the main physicians that used health information were the primary care physicians, surgeons, specialty physicians, (for example anesthesiologists). Both the registered nurses as well as the nurse practitioners also used health care information at Denver Health. When it comes to the specialties and clinics they each have their own team of administrators that handle patients records’ and other vital information. The vendors that bring in medical supplies, drugs, training supplies and anything else that makes Denver Health function also have access to the health information. The medical records in Denver Health are kept both on paper and electronically. Paper records are kept in the specific clinic for thirty days. After thirty days of non-activity they are then transported to the medical records department that is housed in a separate building. Electronic records are kept in two different computer programs. The first is known as EDM. Documents and charts are scanned into EDM where they are stored securely and are available to authorized employees for patient history research. The second program is known as SMS. When a patient is registered into the hospital or clinics the information given will be entered into the SMS program. SMS and EDM are synced together and update each other frequently. Mrs. Nelson stated that programs are user friendly after proper training. Both programs have ways of making user errors less frequent and making navigating patient records easier for medical personnel. The clerical staff and health care providers use Siemens LifeLink Scheduling System. Clerical staff uses LifeLink to schedule appointments and can also check schedules for other local providers. Mrs. Nelson says that it’s nice to use the same software as other local medical health facilities because it allows Denver Health to schedule patients’ appointments around other providers. Also any issues that may come about while using LifeLink is easily solved due to amazing tech support. LifeLink also stores patients’ insurance information, appointment statuses and emergency contact information. The providers also find this useful because they are able to frequently research the patient demographics. Mrs. Nelson added that LifeLink could possibly be the most important software Denver Health uses because without it keeping track of the massive amount of appointments would be impossible. Denver Health has a unique automated system that tracks vaccinations for each patient called VaxTrax. VaxTrax provides reminders to care providers when a vaccine is needed. This is just one more way Denver Health has gone the extra mile to ensure patient safety. VaxTrax has dramatically cut down the likely hood of immunization records “getting lost”. At Denver Health this tool has ensured that most children receive all of their immunizations on time and by their second birthday. Another system that Denver Health has adopted to keep the patients safe is Computerized Provider Order Entry System (CPOE). The purpose of CPOE is to track orders, which minimizes potential mistakes. The system will alert physicians of any drug allergies, drug lab and drug-drug interactions and enables other health care professionals to correctly deliver the physicians orders. Denver Health is part of the ten percent of hospitals to have the CPOE. Security at Denver Health is top of the line. Both patient safety and patient privacy is Denver Health’s top priorities. Each patient is issued a color-coded wristband. Red wristbands show the patient has allergies. Yellow wristbands say that the patient may be at risk for falling. Purple tells the doctors and nurses to check the patients chart for any important information that they should be alert to. The staff at Denver Health is required to wear color-coded uniforms. That helps the patients identify who is providing their care. When admitted each patient is provided with a key to the colors used to be sure that they are aware who is entering the rooms, which ensures patients safety. Patient records are kept extremely secure. Only certain staff is authorized to certain patient information. Each time a Denver Health employee attempts to access patient information they are required to scan their employee identification card. Each employee identification card has a barcode, which the computer will read and only show that employee the information they are authorized to see. For certain medical information the employee is also required to enter a password that only that employee knows. Mrs. Nelson ensured me that each password is extremely secure and not easily decoded. She described that each password must have two capital letters, ten characters long and at least 2 special characters. Each employee is required to change his or her password every 90 days to keep the security level where it is. My webcam interview with Megan Nelson was truly the highlight of my day. She not only ensured me that I was fully capable of working in the healthcare information field but she showed me how rewarding it could be. One thing she made sure to tell me that since she doesn’t have any patient contact a lot of times her and her employees often get looked over. “Healthcare information specialist keep the facility moving and in order” is what she described. One last thing I asked her was if she could change anything about the computer systems she works with and I love her answer! “With this job you really don’t have time to think about the changes you want to made with the systems because they are always upgrading our systems to ensure patient security and to help us navigate it easier” was her reply. Works Cited Denver Health . (2010). Retrieved from About us: http://denverhealth.org Education-Portal.com. (2012). Retrieved from http://education-portal.com/articles/How_to_Become_a_Director_of_Medical_Records_Step-by-Step_Career_Guide.html Health Pro Net. (n.d.). Retrieved from http://www.healthpronet.org/ahp_month/09_01.html How to become a medical records director/manager. (n.d.). Retrieved from http://education-portal.com/articles/How_to_Become_a_Director_of_Medical_Records_Step-by-Step_Career_Guide.html Jobs in Healthcare Adminstration. (n.d.). Retrieved from Healthcareadministrationjobs.net: http://healthcareadministrationjobs.net/medical-records-manager/ Medical Records and Health Information. (2010, September 29). Retrieved from Bureau of Labor Statistics: http://bls.gov/oco/ocos103.htm Nelson, M. (2012, 02 18). Patient Saftey and Healthcare Information Specialist. (S. Romaine, Interviewer)