Our Services

Health Information Management

What we do

The Wilshire Group is dedicated to supporting healthcare organizations who work to achieve the highest quality in the management of health information for the benefit of both patients and providers. To accomplish that, we emphasize teamwork and collaboration in serving the healthcare team to achieve excellence. We understand that successful healthcare delivery requires complete and exceptional systems for collecting, maintaining, leveraging and disclosing patient health information. It is the health information professional who possesses the overall knowledge and skills required for managing:

  • Information Accuracy & Availability
  • Professional & Facility Coding Guidelines and Workflow
  • Documentation Integrity
  • Clinical Workflow & Revenue Cycle Collaboration
  • Information Governance/Reporting
  • Regulatory and Accrediting Requirements
  • Protection of Patient Privacy
  • Support System Implementation (computer-assisted coding, document management systems, transcription, etc.)

Our services cover all aspects of HIM, and our seasoned HIM professionals can help transform your organization’s health information department. With our support, your organization will experience more effective and efficient health information systems, improved processes and an increased return on your HIM investment.

Contact Jennifer Esterbrooks today to learn more about how The Wilshire Group can partner with you!

Focus Areas

Coding: Leadership, Quality Improvement, Education, and System Enhancements

Very few industries are as dynamic as healthcare in terms of new technologies and government regulation. Wilshire recognizes that frequent changes in healthcare technology, policy, and reimbursement translates to a need for strong leadership and continuous education in healthcare facilities. Our seasoned HIM consultants posses years of Epic Revenue Cycle experience with the ability to understand metrics, workflow and staffing considerations. We stay focused on quality, regulations and enhancing your workflow while making necessary recommendations providing insight into Epic optimization.

Supporting a healthy revenue cycle our educational programs combine coding regulations and guidance with clinical information, revenue enhancement opportunities, compliance considerations, and documentation requirements to bring full scale, practical training to your staff. Whether your needs are to educate a small group of individuals from a single department or to provide integrated interdepartmental training, we can customize a training session to meet your needs. Our education model combines information about your facility’s case mix with baseline audit results, audience consideration, proprietary training materials, and expertise to improve charge capture and coding accuracy.

Our system audits review all aspects of your coding workflow to ensure that:

  • Coders focus on the one thing that matters most for them: coding
  • There are no gaps nor overlaps in your coding workqueues and DNBs
  • You are leveraging the system in the most efficient manner possible
  • Your coders are able to locate documentation quickly & consistently
  • You are taking advantage of system automation where possible – for instance, Simple Visit Coding

We are deliberate to ensure that we take into consideration other departmental workflows and downstream system impacts to create efficiency, consistency, and clear communication, resulting in optimal design and system workflow.

Clinical Documentation Integrity

The Wilshire Group approaches Clinical Documentation Integrity with a uniquely deep combination of clinical expertise and technical skill. Like you, we are quality–focused and patient–centered. Our strategy can take your organization with complete confidence all the way from basic revenue enhancement to complete health record integrity.

Every healthcare organization faces formidable challenges with an EHR implementation, physician engagement, measuring and interpreting CDI results, optimizing CDI staffing and establishing appropriate financial support for long term quality improvements. The unique interplay of systems, processes and resources at your facility can make keeping pace with technology difficult. Even small discrepancies between clinical verbiage and actual coding can result in serious revenue loss and impact quality profiles over time.

Wilshire has a holistic understanding of how to drive increased quality in every documentation stage, from the operating room to the accounting department. This knowledge allows us to provide laser focus on your specific challenges while never losing sight of the big picture. So your systems run efficiently. So your processes run smoothly. And your resources work for you, not against you.

Long term, we believe that the best strategy is to improve documentation across the board and achieve a higher multiplier on services provided. No matter what CDI challenges you face, we are well prepared to help you meet them head–on.

Deficiency Tracking Maintenance, Optimization, and Reporting

Providers’ least favorite phrases: deficiency, outstanding documentation, delinquent chart…We know these phrases all too well. Often times healthcare organizations implement a deficiency tracking solution…and…leave it at that. They just accept whatever the system outputs – sometimes it’s too difficult to find the corresponding clinical documentation, sometimes the documentation lives on paper that’s still waiting to be scanned, or sometimes people just think that the system is working like it’s supposed to.

From our experience, a deficiency tracking solution isn’t something that you simply flip on and forget about. Monitoring the accuracy of the system is a must:

  • Have you updated your deficiency system since all of your clinical documentation/orders went live?
  • Have you ensured you are taking advantage of all available auto–triggers, auto–assignments to providers and auto–completion of deficiencies?
  • Does the system incorrectly create outstanding deficiencies for certain departments or procedures that should be excluded from documentation requirements?
  • Are your analysts enjoying the most efficient workflow that could eventually allow some or all of them to work effectively remotely?
  • Does the system properly reflect your organization’s overall delinquency rate for The Joint Commission or DNV reporting?
  • Can medical staff and HIM managers easily assess their delinquent metrics?
  • What about clinic deficiency tracking? Have you determined what you are tracking, why, how & who monitors missing elements in your clinic settings?

Often times, clients experience issues with at least one of these scenarios. Every healthcare organization is different: different documentation requirements, state regulations, accrediting organization standards, practicing physician models, documentation and ordering workflows, etc. Wilshire can offer the insight and experience to diagnose systemic issues within your current system configuration and existing workflows. We work with you to understand the unique challenges and requirements that your organization faces to develop system alterations and workflow enhancements that meet your specific needs. With our help, your system will adhere to your organization’s policies, procedures, and regulatory requirements in an efficient and consistent manner.

Legal Medical Record and Release of Information

Each organization must define the content of the legal medical record (LMR) to best fit its system capabilities and legal environment. Considerations for the content of the LMR should include ease of access to different components of patient care information, guidance from the medical staff & the organization’s legal counsel, federal regulations, and the requirements of third-party payers. We recognize the challenges associated with the impact of technology on the legal medical record:

  • Completeness: Ensuring that all pertinent clinical documentation has been captured, even if that data lives in multiple systems and mediums (electronic and paper)
  • Consistency: Ensuring that all releases have a consistent look and feel, across patients, encounters, and time
  • Customization: Ensuring that your LMR configuration and supporting documentation adapts alongside your continually evolving EHR via continual auditing and maintenance
  • Compliant: Ensuring that your LMR adheres to the latest billing and regulatory requirements

It is our goal to work with you to build a collaborative work group of members from provider settings, law practices, information technology vendors, and information systems to develop guidelines to assist your organization in defining your LMR. Wilshire provides the expertise and experience to establish auditing, maintenance, and versioning policies & procedures required to support a complex electronic record.

We will also assist you in creating the day to day workflows for effectively and consistently releasing patient information, such as: interdepartmental communication & routing workflows, reports and dashboards to monitor workflow and quality, and optimization of your current ROI module.
Our expertise also extends to areas like E–discovery and managing the “hybrid” patient record (electronic & paper records). We will help you define the difference between your LMR and E–discovery, advise on appropriate E–discovery build, and devise workflows to accommodate releasing E–discovery data. Furthermore, we will help you define the appropriate processes & procedures to manage patient records across different mediums and databases (e.g. your EHR and Document Management System), with the ultimate goal of ensuring consistency with your release processes and accounting of disclosures.

Confidentiality of Chart Maintenance

In today’s digital healthcare world, patient confidentiality is a hotly debated issue. Healthcare organizations often struggle to define a balance between restricting access to patients’ electronic medical records (often per patient request or regulatory compliance) and providing an appropriate level of access to these records to ensure safe patient care. HIM is typically responsible for “maintaining” the chart. Due to this unique positioning and often close ties with the Legal, Risk, and Compliance departments, HIM occupies a unique position to address confidentiality concerns. Our operational staff and certified HIM consultants bring their past client experiences, up to date compliance and regulatory knowledge, and Epic expertise to the table in order to devise efficient, manageable solutions that address your organization’s confidentiality needs while ensuring that appropriate hospital staff can access pertinent medical records to provide patient care.

Whether your organization needs advice on registration and billing workflows to address patients’ confidential requests, limiting access to portions of patient records, restricting certain documents in your Document Management System, how to handle Employee Health records, or just how to tackle a topic so complex and integrated as patient confidentiality, we have the expertise to assist.

Additionally, we are great resources to offer advice & structure on how to best maintain the chart. If “why does my Chart Review look different from yours?” & “why don’t I have the Cardiology tab?” are questions heard in your organization, we can set you up with a plan to streamline and make chart consistency a norm.

Clinical & Revenue Cycle Integration

Often, problem areas are so because they don’t have clear owners. In the EHR world, there are many of these issues that don’t lend themselves to a single application owner. We take the “full picture” approach when it comes to integrated topics, drawing on both our revenue cycle and clinical system experience and project management finesse. A couple examples of areas we’ve assisted in the past:

  • Revenue Cycle Collaboration: With much focus in the industry on reimbursement, DNFB, and compliance, this is a spotlight of interest more than ever! We’ve helped on integrated claim edit projects and forming revenue integrity departments.
  • CAC (Computer Assisted Coding): New technology is necessary to keep up with the industry demands – we have implemented this from beginning to end.
  • Document Management System (DMS): Draw on our experience to ensure all paper documentation is appropriately scanned to reflect a complete picture of care provided to the patient. Auto–indexing and moving to e–consents are current projects to consider.
  • Master Patient Index (MPI): As you add clinics & hospitals to your system, do you have someone familiar with patient indices to manage this project? Patient matching scores and chart correction processes are crucial to a clean patient population.
  • Provider management (including admitting, attending and ordering privileges), unsigned orders and admission order workflows are just a few of the other subjects in which we have much experience.

Our seasoned health information management and information technology professionals are familiar with healthcare operations, system setup & workflows. We understand how the work HIM does supports the health system and impacts information availability for patient care, coding & billing, and patient disclosures. HIM is the “glue” that binds the clinical and revenue worlds and meets the demands of an ever–changing compliance landscape, while ensuring support of the organization and providers that serve the critical work of patient care.