August 1, 2019 – I was back at Copley today to visit with the health information management team. They work to assure that patient information is secure, accurate and updated in a timely manner. It’s a big job that is always evolving with health care technology updates.

Senior Director Dorothy O’Hagan shared that, in the mid-80s, the master patient index (which is the log of all patients seen at Rady Children’s and includes names, dates of birth, medical record numbers and encounter dates) was updated by hand with a pencil and stored on index cards. Today, the master patient index is contained in Epic and has more than 2.3 million patients!

Thanks for the warm welcome!

My visit began with a lei greeting: one was a traditional flower lei, and the other was made out of paper leaves with handwritten messages from the team. Very cool idea!

Then it was time to board the HIM Express for my tour through each HIM team. First up was the Data Integrity team. This group of six reviews more than 8,000 patient records every month, validating critical data elements. They also review and audit patient charts; identify EPIC technical issues and assist customers with navigation; process EMR requests from providers around the world; and work closely with public health nurses, newborn screening staff and Fresh Start Surgical Gifts.

My next stop was at Scan City, the team that is responsible for scanning patient documents from the main Hospital and all of the satellite locations. From October 2018 to June 2019, they scanned an average of 100,000 documents every month and audited a total of 70,814 documents, ensuring accurate processing into each patient’s chart. This group also handles Infra requests and importing e-file documents into EPIC.

Hopscotch at the wheel of the HIM Express

The HIM Express made its next stop at the CDI specialists’ station. As one clinical documentation improvement team member described it, they work to “paint the complete clinical picture of the patient when they are admitted to Rady Children’s.” They are also the clinical documentation police, ensuring the quality and comprehensiveness of patient data with the goal of having the final documentation fully describe why the patient was treated at Rady Children’s, from the time they come through the door until the time they leave.

Next, it was all aboard for Coding World. This group of 24 coders (15 full-time, six part-time and three per diem) assign diagnostic codes for both inpatient and outpatient settings. As an example, they took me through the code journey of Hopscotch, a fictional patient who happened to be a teddy bear. Unfortunately, Hopscotch was diagnosed with Hodgkin lymphoma, but did make a full recovery! Through his journey from the ED to inpatient and outpatient visits, Hopscotch had 32 codes assigned, including R59.0 (enlargement of lymph nodes) to 36590 (removal of tunneled central venous device).

My stop at Coding World

The HIM Express chugged along to our next stop at the Release of Information team, which handles requests for patient medical records. These requests come from a variety of places, including parents and patients, law enforcement agencies, attorneys, schools, and insurance companies. About 20 people stop by Copley every day to request medical records in person. If these are parents, the team signs them up for MyChart, which allows online access to patient records. This group is the last set of eyes to review the records before releasing them, and they take that responsibility seriously.

My final stop was with the Application Support team. This small but mighty group supports the Health Information Exchange and its applications: Carelink, MyChart, Right Fax, San Diego Health Connect and Transcription/Mmodal. I learned that they support about 5,000 MyChart activations and approximately 200,000 logins each month. They also support decision-making, collection of data and data analysis, and are working on special projects like the AMBRA image exchange and the scanning reduction initiative.

One of the messages on my handmade lei

While all of these teams have their own unique duties, they are united in their focus on accuracy, quality and data integrity. We couldn’t succeed in fulfilling our mission without their dedication and high-level work.  Thanks again for all that you do.