All hospital information systems utilize tables, dictionaries and profiles to customize their vendor’s software.  The values placed in the tables often represent “policy and procedures” of how the business runs.  Some tables can be dynamically displayed using help screens and these are not a problem for users of the applications to know the values.  However, many tables are more complex than simply displaying a list of values.  The problem is, management may not know the values in the tables and may not have sufficient access to this information.  Even if access is available, they may not understand how to readily read them because the format is dictated by the vendor. 

The primary knowledge of the tables resides in IT because they are responsible for the management and maintenance.   Management and end users of the application may understand the decisions at the time the system was implemented but as turnover happens in both IT and the user community, the knowledge of the decisions goes with the turnover.  Managers lose sight of the values and the POSSIBILITIES of what can be changed to improve their application.  We know that healthcare rules change constantly and the ability to update the tables need to change also.   One of my frustrations is hearing a new user of a system put the system down because it cannot do this or that when in reality, a table change may be just the ticket.

To accomplish knowledge transfer, I institute application documentation of table values to be available to the users.  I know, “documentation” is a terrible word and what is even worse – actually doing it.  But I truly believe it is a necessary evil.  I refer to my documentation daily and when a user asks me a question, I show them the documentation to improve their understanding of their “Policies and Procedures”.  In addition, they also learn and know what can be changed.

I have often found table build and data entry errors while updating documentation.  It is like a second check to what goes into production.  I may think it is a certain way, but once I put it on paper, I may find it is not running like it was designed.

Let me give you an example:

** Keep the documentation in Alphabetic order because managers do not want to remember technical names.  A “Table of Content” at the beginning of the document is a must

** XXX-KUP15GC at the top indicates the hospital and the table identification.  This way, I can walk into a new hospital with a shell of the documentation and substitute the XXX with the hospital name when completed.

** The next listing of tables is important because it indicates tables that need to be reviewed when this table changes.

** The date and initials is the last time this table was reviewed and documented.  I have used this to catch up the documentation when I have been away from a hospital for a span of time.

** I highlight areas that change as new releases are implemented.  This way, managers and users can see what is changing with the release upgrades.

** And lastly, the actual documentation.  I can look quickly and see in this example that “B” (line 3 Blue Cross) has a 4 day hold for charges to be posted and holds forever (999) for the diagnosis to be completed and insurance to be verified.  This is truly “Policy and Procedure”.

I agree it is tedious.  I agree it is “Microsoft Word”.  But it is the tool used now until the vendors can produce something more readable and accessible to managers and end users.

As a consultant, I perform table/profile reviews for hospitals and often find errors in their setups.  I propose recommendations that can be made to enhance revenue.  I find changes that can be made to meet compliance and reduce denials and changes that can reduce manual work being done on each account prior to billing.  How did the biller know they were doing extra work?  They may not know the application other than how to “Fix it” to get the bill out the door.  The hospital gets recommendations from a review as well as DOCUMENTATION when the review is complete.

To learn more about how Santa Rosa Consulting can assist you with your “Policies and Procedures”, contact us at contacus@santarosaconsulting.com.