Residency Journal at Rady Children’s Hospital

Week 1 (1/30-2/2) 21 hours (7, 7, 7)

This week I did was at the residency site for a total of 21 hours (7 hours for three days). The

preceptor (Dorothy O’Hagan) wanted me to help out with analyzing how Rady Children’s

Hospital could increase their financial strength by including proper diagnosis codes for

reimbursement. I analyzed what ICD-10 codes were used by multiple different children’s

hospitals around the country and compared them to Rady Children’s. I formed a spreadsheet of

which ones were used at each hospital that were not used by Rady Children’s of those patients

with similar diagnoses. This would help show where Rady Children’s might be able to increase

reimbursement from missing certain codes that should have been included that would increase

the severity of illness for the patient.

Week 2 (2/6-2/9) 17 hours (6, 6, 5)

I continued with the analysis from the previous week of forming the Excel spreadsheet with the

different diagnosis codes from similar cases. This task worked on my analytical ability and

exercised my skills in managing detail. I made great progress. Examples of children’s hospitals

included Texas Children’s and Boston Children’s.

Week 3 (2/13-2/16) 5

I only came in this week on Thursday for 5 hours due to graduate school commitments. I

continued to make significant progress on the analysis of different hospitals and how Rady

Children’s could increase its reimbursement rates from comparison of similar cases.

Week 4 (2/20-2/23) 20.5 (8, 5, 3.5, 4)

This week I came in everyday (besides Mondays because the preceptor, Dorothy O’Hagan, said

they could not accommodate me due to some of the remote coders coming in and cubicles were
 limited). I worked with some of the business analysts there (mostly Alejandro Castro), and he

helped me analyze the lists I was constructing with the various codes that could be added to

Rady Children’s diagnoses forms. On Friday, I went to a different location, the main hospital, to

shadow a PACS administrator. One of the managers (Jared Vogt) helped set that up. It was

enlightening to see what he did as a career, and he helped me get connected to others in

healthcare I.T. within the community. He mostly worked in the radiology information systems

and made sure that radiologists could upload, maintain, and access the pictures needed to

diagnose each patient. His career significantly piqued my interest in going into the field.

Week 5 (2/27-3/2) 10 (4,6)

I came in twice this week, and I finished the list of diagnosis codes that Rady Children’s had not

implemented during their reviews. I sent the list to the coding manager and she reviewed it in

detail. I was then assigned another project to work on by the analyst (Alex Castro). The hospital

was doing an audit on over 300 pediatric patients in order to see whether or not the respiratory

therapists were documenting the oxygen flow rates correctly at point of care. My task was to

enter each of these patient’s charts and verify whether the recorded flow rate was within the

flowsheets in Epic (their electronic health record). I then made another Excel spreadsheet

showing which ones were not documented correctly. This task was time-consuming and tedious,

so it worked on my traits of perseverance and follow-through.

Week 6 (3/6-3/9) 16 (5, 5, 6)

This week I continued to go through the list of pediatric patients, verifying their oxygen flow

rates to determine accuracy of what was documented. This activity helped me with my skills in

navigating through health information systems to find information, particularly the Epic system

(which is the most used in America, so a valuable skill). In order to find the information, many
different buttons within the system needed to be clicked, and information needed to be typed in

in order to find each patient. Again, this was a tedious process that worked on character qualities

of patience, consistency, and follow-through.

Week 7 (3/13-3/16) 10 (4.5, 5.5)

This week I continued with the same task of auditing the flowsheets to determine accuracy. Also,

the analyst I was working with added other components for me to record. Each time I accessed a

patient chart, I recorded the HAR (Hospital Account Record) for the patient to the Excel

spreadsheet. This aided in record recovery in the future when reviewing the spreadsheet. Alex

(the business analyst) additionally directed me to record the delivery device of oxygen

administration, as well as determining whether the maximum oxygen flow rate was greater than

5 LPM (liters per minute), which indicated potential respiratory failure. I also recorded whether

or not each individual was diagnosed with respiratory failure or not, and all of this data was

added to the spreadsheet. The goal of recording all this data was to assist in determining a

hospital-wide criteria for diagnosing pediatric respiratory failure, which became my capstone

project.

Week 8 (3/20-3/23) 4

This week, due to graduate school commitments, I was able to only come in on Friday. I

continued updating the master spreadsheet for all of the data to determine hospital-wide criteria

for respiratory failure. The goal was to see how many individuals met the arbitrary standard of >

5LPM of oxygen administered but were not recorded as having respiratory failure. Queries

would then be sent out to the associated physicians to determine why they were not diagnosed

with the condition. This is significant because having this failure will qualify for significant

financial reimbursement, so accurate recording is paramount.

 Week 9 (3/27-3/30) 15.5 (6, 4, 5.5)

This week I came in and continued work on the master spreadsheet. Recording all of this data

was of vital importance to the hospital in order to affect change management for accurate

documentation of respiratory failure. This worked on my skills of problem-solving as sometimes

there were issues with accessing the needed data within Epic, and alternate pathways to find the

vital information were required. With my goal of becoming an analyst working within medical

health records, this direct experience was of significant importance.

Week 10 (4/3-4/6) 6 (2, 4)

This week I was only able to come into the residency twice due to outside commitments. I was

nearing completion with the data compilation within the spreadsheet. Collaboration with the

analysts was also completed. I shadowed what business analysts do day-to-day, and this opened

my eyes to the career. Before shadowing them I had a rudimentary understanding of their job

duties that was mostly academic in nature, but afterwards I could more easily explain what they

did for the organization. This experience helped me want to become an analyst.

Week 11 (4/10-4/13) 11.5 (4, 4, 3.5)

This week of residency I finished the spreadsheet that my capstone was based on. I uploaded all

of the data that was required to determine respiratory failure within the hospital, and sent the

spreadsheet on to Alex, the analyst I was working with. He then sent it on to the clinical

documentation improvement specialist that was spearheading the project. She looked at the data I

collected and was thankful for my assistance. She used it to determine how to put together a

presentation that she would give to the clinicians to open their eyes to the need for adherence to a

standard definition for diagnosing respiratory failure.

 Week 12 (4/17-4/20) 9.5 (4, 5.5)

Since my task of collecting the respiratory failure data was completed, the manager of the

analysts within the office (Jared Vogt) gave me another task. They had the need to upload patient

POLST (Provider Orders for Life-Sustaining Treatment) forms into San Diego Health Connect,

which is an interface that can be accessed from many different avenues or medical providers.

Jared gave me the task to do this. The benefit would be that in the case of an emergency,

providers could determine what the patient’s wishes were about sustaining their life. This task

was arduous and monotonous, but it helped me focus on building my qualities of perseverance.

Week 13 (4/24-4/27) 11 (4, 7)

During this week, I continued uploading numerous POLST forms into San Diego Health Connect

from another internal image storage system. This helped me realize the complexity of some of

the tasks organizations have to endure. All of the POLST images have to be downloaded from

one system, saved onto the system Rady uses, then uploaded to the San Diego Health Connect.

Each of these steps had significant substeps within them and took much time. When uploading to

the Connect, data was recorded from multiple localities which also increased the complexity of

the task. This week provided me with further issue resolution skills and worked on my critical

thinking abilities.

Week 14 (5/1-5/4) 4

I had been making progress on the long list of POLST forms to be uploaded, and this week I

made additional progress. However, there were some issues that were bothersome. Certain

patients’ forms would not upload adequately, and I was having a difficult time figuring out why.

I consulted with various other analysts within the office, but they were not able to figure the

reason out either. Finally I was told to skip over those with issues and complete those that had
none. This task further worked on my critical thinking for future employment endeavors as well

as my tenacity in overcoming resistance.

Week 15 (5/8-5/11)

This was my last week, and I came in on May 11 to say my farewells and thank those I worked

with. I sent my progress on the POLST forms being uploaded to the San Diego Health Connect

to my supervisor (Jared Vogt), and wished everyone well.