HIS BILL” Health Information Systems Implementation

NAME OF HEALTH DEPARTMENT: Warren County Health Department

PROJECT TITLE: “HIS BILL” Health Information Systems Implementation

Jessica Crawford
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Project Overview

Project Aim:      
The recent implementation of the Health Information System (HIS) has presented a new challenge for our billing process by increasing the amount of staff time required to key entries and the number of errors occurring in the billing process.  This issue is extremely important to the overall financial stability of our health department and our need to maintain revenues that are greater than department expenses.  Our aim is to greatly improve the efficiency and accuracy of our clinical billing process by June 1, 2011, thereby increasing our department revenues.  We will accomplish this by focusing on strategies to reduce distractions of our billing staff which will improve their attention to detail.  We will cross train additional front office staff  (employees already on staff) to enter billing data, and improve the actual workspaces utilized by our billing staff to make the area more efficient.


  • Department annual adjusted monthly clinic revenue will increase by 10%
  • Reduce the time for keying billing entries by at least 50%
  • Reduce the number of repetitive billing errors by 70%
  • Improve staff satisfaction (administration, finance, & nursing) from 50% to 80% by improving workflow and ergonomics.

Project timeframe:

  • November 2010 to June 1, 2011

How was the need for the project determined?
This project was fiscally motivated.  With economic times being as difficult as they are, we wanted to focus on ways to increase revenue by decreasing the need to rebill Medicaid this required us to look at two factors that affects billing errors:  staff satisfaction, and training on HIS.

Does this quality improvement project link to accreditation?
HIS Bills quality improvement project is directly linked to Warren County Health Department’s initial accreditation program.  HIS Bills project allowed WCHD to develop and implement a continuous quality improvement program which is essential to the success of our health department accreditation.  Furthermore, our continuous quality improvement team provided key individuals that can review and improve existing functions so as to help WCHD achieve accreditation status.

Areas for Improvement and Change Ideas Implemented

Improvement 1
Designate one WCHD staff member to strictly work on billing thus allowing this individual to be able to generate more income and reduce the amount of re-bills for the entire Health Department.

  • We discovered by dedicating one individual to strictly billing that in most incidences the amount of re-billing dropped by approximately twenty percent which increased revenues.

Improvement 2
Re-organize the management support area thus moving the primary billing WCHD staff away from the front check-in window.

  • This change not only resulted in a more efficient process but also resulted in significant higher morale whereby the WCHD primary billing staff member was able to stay focused entirely on the billing process without any disruptions

Improvement 3
Identify specific areas of flow where health department staff traffic needs to be diverted away from the billing area, so as to minimize the disruptions in the area.

  • In the initial stages of our HIS Bills project, we decided to try and designate one management support staff member for each of our clinics that other staff members could go to so as their contact and/or help person without disrupting the billing staff member.  While this procedure essentially met so resistance, eventually staff began using the procedure and thus cut down on the amount of billing error.


Overall Improvements

  • Re-organized the front office to provide for more efficiency
  • Decreased the number of re-bills by approximately twenty percent
  • Decreased re-bills has resulted increased efficiency and slight increase in measured revenues by approximately five percent.
  • Substantial increase in improved team work and overall employee satisfaction.

Lessons Learned:

  • Not all staff is truly committed to how well Continuous QI can improve the overall functions of the health department and thus often provided negative comments to other staff. 
  • Next time, we would definitely focus on a larger project that would allow more staff to be directly involved so as to see the benefits of the project as a whole.
  • It is important to realize in the beginning how much effort and concentration QI takes each and every day to allow the process to move forward.

Programs supported by:

BlueCross BlueShield of NC FoundatoinThe Duke Endowment

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